Question:
Is being precertified the same as being APPROVED?

My paperwork is in, I've called Aetna 3 times in 2 days 'just to ask questions' My first question was directed to 'member services' Q: Is Gastric Bypass Surgery covered under my plan?) A:Yes, if your PCP considers it medically necessary and the surgeon is within the network. (okay assume I'm dumb...) Q: What does medically necessary mean? What's the Aetna criteria?) A: BMI>40 or BMI <35 w/ comorbids. Q: Is that it? A: Yes, that's it? Q: So then I call precertification which I thought was similar to member services) Q: May I check the status of my approval? A: You have a clause in your 'something' that does not penalize you for getting precertified for surgery? Q: Really? What does that mean? I can set my surgery date? Q: You have not done that yet? A: Well, no. I was under the impression that I needed to get approved. Q: You are approved if you've met the criteria. Have you talked to member services? So, what I got out of the dialogue is that I've been precertified, is that the same as preapproved? Man, I'm confused! Someone help PLEASE! email me at [email protected]    — corpdiva2006 (posted on January 17, 2001)

January 17, 2001
I would think that the surgeon's office would still need a pre-auth. So that they know they will get paid. (I had insurance approval via my HR department even had them type up a letter - but the Docs office said, nope, they need something from the insurance company.) I guess I would work with your doctors office, so they have everything they need so then they can't come after you for the $$. Just my thought...
   — [Anonymous]