Insurance Trouble - Now what do I do.

I had a consult for abdominplast in February.  My insurance paid the entire $340 for the consult.  My surgeon submitted everything to insurance for authorization.  He include documentation from my physicians regarding rashes and infections as well as the pictures which were taken at the consult.  I even had a rash at the time of the consult which was also documented in the pictures.

Today the surgeons office called to tell me that my insurance says I don't need pre-certification.  Huh?  It seems that my plan, an indemnity/wrap around empire bc/bs does not require pre-certification and does not review cases prior to surgery. 

They say I should have the surgery (the surgeon should know if I meet the criteria for medically necessary surgery) and then the surgeron should submit all the documentation with his claim.

Anyone have any experience like this?  I have no idea what to do now. 

/ilene

Sounds like it would be helpful to call your insurance and get the step by step information of what is going on. What I read seems to leave allot in the air. What if you have the procedure and the doctor submits the claim and they deny it? I would want some clear answers.

What do you think?

Teresa

That's the problem.  I did call the insurance company.  Under my plan they don't do pre authorization or pre certification.

Word to the wise: You will need to be prepared to pay the cosmetic price for this procedure, and get an estimate of the costs beforehand so you'd be prepared to handle it should this be considered a non-covered benefit after the surgery. If your pannus is not a slam-dunk one of those down below mid thigh or with raging paniculitis, you do run a very real risk of ultimately having to pay out of pocket at the end of the day.