X-POST Useful Medicare PA insurance nugget
In my quest for prior authorization to have excess skin removed from my thighs, I got this little nugget of information from Medicare - I'm going to check with my replacement plan to find out if it works this way with them:
If the surgery is done on an outpatient basis - insurance *cannot* be submitted for prior autthorization retroactively. GUARANTEES non-coverage.
If the surgery is done INPATIENT - including hospital stay for at least 24 hours post op - retroactive PA can be done *up to 90 days post-procedure* They could conceivably still deny, but I'm thinking if inpatient is necessary, they would be nuts not to! If they did, you could still appeal!
If the surgery is done on an outpatient basis - insurance *cannot* be submitted for prior autthorization retroactively. GUARANTEES non-coverage.
If the surgery is done INPATIENT - including hospital stay for at least 24 hours post op - retroactive PA can be done *up to 90 days post-procedure* They could conceivably still deny, but I'm thinking if inpatient is necessary, they would be nuts not to! If they did, you could still appeal!