Question:
Authorization Number but not approved or denied yet?

Has anyone ever had their insurance (I have Cigna) give them an authorization number but tell them that they are not approved or denied yet. I called to check status of my pre-certification/authorization for surgery. The girl in claims checked with Health Services. She told me that they had received all the paperwork from my doctor. She gave me my authorization number in case I need to call back about anything. And, then she told me that I hadn't been approved or denied yet. She said that Health Services had done an "outreach to the doctor" and when they got that information back I would have a decision within 24-48 hrs. I didn't think you got an authorization number until you were approved for the procedure. Is this a good sign or bad one? Has anyone heard of this?    — judylj60 (posted on November 16, 2003)

November 16, 2003
It's probably just a 'tracking' number they use with all of your information regarding this request. A way for them to pull your file so to speak.
   — RebeccaP

November 19, 2003
Hi, I happen to work for a medical review company. It is standard practice to open a file with a case # that has the demographics and providers in it, the medical info is put into the file and then several things can happen: 1) depending on what is being reviewed, it may be able to be processed right then and a decision is given, ONLY THEN does the case # become the precert #; 2) further clinical is needed or maybe it needs to be sent for the md's to review for a decision, in that case nothing has been certified or approved, so the case # does NOT become a precert # unless it gets approved, it is merely a case # until a decision is made. This is standard and not unusual at all. There needs to be a system where info can be handled and also easily brought back up as needed to be worked on. So any time a file of any kind is opened up, but no decision is made right away, you should be told the case #, but won't be told it is an authorization or precert # until something has actually been approved. (If something is denied, then it remains a case #, but not a precert # as nothing was approved.) Of course, everything is based on the plan your employer has purchased, but this is pretty standard with any precert company. I hope that answers your question?! good luck on your journey!! karen (open rny 9/6/01, 297/147)
   — Karen M.