Question:
Has anyone else heard that BC/BS FEP now requires precert?

At my surgery consult, I was told by the business administrator that BC/BS FEP is now requiring precertification. Has anyone else heard this? I have TriCare through my husband (retired AF) also, but would like to use both so my out-of pocket is minimal.    — Linn D. (posted on January 25, 2004)

January 26, 2004
I have Anthem Blue Access PPO which required both a pre-determination (medical necessity) and pre-certification. I suspect all the Blues will be similiar. To me it seemed rather stupid to submit twice, but approvals for both were rather quick, just a few days each. The amazing part is that they didn't pay for the initial consult until after the pre-determination was approved. Then I had to have all the original bills resubmitted again. It's no wonder with processes such as these, insurance is so expensive.
   — rleffler

January 26, 2004
I have Empire BC/BS PPO & I am waiting for the answer to my pre-determination. But I am curious as well. What is the difference between pre-determination & pre-certification? I was just told that I had to submit to prove medical necessity before they would "approve" the surgery. I'm sorry I'm answering your question with a question & if you find anything out, I would LOVE to know!!!! Good Luck! ~Amanda :)
   — amandalianne