MORONS at the ins co?

I tried to call Horizon BCBS to confirm that my surgery is authorized and you would not believe (or maybe you would?) the run around. The clerk just kept telling me that I have a predetermination that is approved but also marked pending. So what does that mean? How can I be approved and pending at the same time? Isn't the definition of approved that the decision is made? *sigh* Then he tells me that if my doctor has any questions, he should call their provider telephone number. So I tried to explain it to him logically. I said, sir, I am just trying to CONFIRM that I have been approved, because a week after surgery, if BCBS denies the claim, who is going to get stuck paying? Not the doctor - ME. So *I* need to confirm it. And he basically wouldn't talk to me. Apparently I'm not authorized to know if I have insurance coverage or not. We'll just keep that as a happy surprise for a few weeks after I get out of the hospital. *sigh* Anyone else had better luck with Horizon BCBS NJ? Do I make sense to you guys at least? (even if I don't please just lie, I'm really flabbergasted over here.)

DearJenifer, i would suggest calling back and asking for a supervisor. Sometime I have found that when you get an idiot on the phone it is just better to go above them and deal with someone who knows what they are doing. also keep a ledger of who you spoke with, date and time. otherwise you will have a nervous breakdown. I am crused with HALFTIMERS i know i am on my way to alztimers so I have found documentation is everything. So call back try a different person and if that does not work ask for the super..you will probley get better results. also ask the to send you a letter of approval for your records. My insurance Qual Care always send me an copy of any pre set arthutrazation needed. So I would also ask them for that. good luck! joyce

I agree with everything Joycelyn told you aabout writing names and calling again. I also have found that when the drs office calls in the precert, a nurse reviews the information sent , and then it sometimes is forwarded to a Dr at the ins co to confirm you meet their criteria and then approves or denies it. This may take a few days. Good luck and I hope you get good news soon!