Question:
How can I get around being with my company for 1 year of pre-determination?

Are insurance started on 11-1-00 and soon as we got it I called to find out what I had to do to get pre-determined and the insurance company told me that the company we have insurance through requires us to be with them a year before they will do pre-determination. In other words, I have to have the surgery first and then put in a claim to see if they thought it was medically neccesary. Is there anyway around this? Do you have to be pre-determined before you can have the surgery?    — Michelle C. (posted on November 17, 2000)

November 18, 2000
By all means I would have surgery! If your dr. seems to think that you are eligible, don't worry, they will prove it. I had the same thing told to me by my insurance co. and my surgery is on 11/30 and to my dr. and his office staff that was approval enough; Because they know that it is a medical necessity. I believe that if you have the right surgeon his or her office staff will handle getting you approved. I would not reccommend having a surgeon who wants you to write or prove it to the insurance co. yourself. And by the way I would rather be done had surgery and appealing to them to pay for it than appealing for them to pay and not have had it yet! Can't get blood out of a turnip for it only has turnip juice! I would also call my human resource dept. at my job and see what they have to say in reference to what they stated. I believe that if you have the right surgeon then he or she will take care of getting you approved and showing medical necessity.
   — TANGIE B.