Question:
Don't understand this letter....

I got a letter from my insurance company today saying the surgery appears to be medically necessary and under my employers plan I am elegible but they won't say weather they will pay for it until after the surgery and after a claim is sent in. What does this mean?    — Cynthia A. (posted on June 11, 2003)

June 11, 2003
Sounds like you are approved but "authorization does not guarantee payment" which is kind of a standard line. As long as you are in network with your surgeon and facility, you are probably okay.
   — koogy

June 12, 2003
It means that the insurance company is giving themselves a way out. Every time I verify insurance at the office I work in, this disclaimer is either played from recording or said by the insurance rep: "Verification of benefits is not a guarantee of payment. Actual benefits will be determined at the time the claim is received." EVERY insurance company says this, but few do not pay as quoted. Personally, to be on the safe side, I would talk to a customer service supervisor or precertification rep and ask for a more detailed statement. Or, call your surgeon, ask what CPT code will be billed, then call the insurance company and ask them whether CPT code xxxxx (it will be 5 numbers long) pays and with what diagnosis. Good luck!
   — Liz R.