Question:
Retroactive requirements for surgery?

I have already been approved and surgery set date from BC/BS. I would have had this surgery in September, however my scheduling issues caused a delay until November. Now, having ALREADY been approved by insurance in August--they have decided to also require cardiac clearance--even though my surgeon and PMD have nixed it. Can they do that retroactively? I was signed off on and ready to go!!! I do have the customer rep looking into it--but is this a battle I can win 2 weeks before surgery? Also, the surgeon's office said they received a list of 2 dozen people this applied to--some who already had the surgery!!!--and some who were scheduled the very next day. Any suggestions? Is this nuts?    — Wannabe A. (posted on October 19, 2002)

October 19, 2002
Yes, they can do that and it is usually standard procedure to require a cardiac clearance before a procedure. Your primary doctor can refer you to a cardiologist for the clearance. If your EKG is normal then you can be cleared with that alone. If there are any abnormalities on it then you probably have to do an exercise stress test and an echocardiogram. If you are not able to get on a treadmill machine, then a cardiolite adenosine stress test will have to be ordered. This can be a hang up because of scheduling delays. When scheduling with the cardiologist, if they know that there is a surgery date already, they can get you in to do this in plenty of time. Knowing this in advance and working for a cardiologist, I had my cardiac clearance in my hand when I went for my first consult. My surgery was scheduled within a matter of weeks and I did not have to wait long.
   — Sue A.

October 19, 2002
Dont worry I got a cardiac clearance less than one week before surgery. Like others said just tell them its a pre op rush. Its no biggie and chances are your fine. But IF you do have a problem better to find out before surgery so its mangeable rather than when your on the table. My surgeon says its the unknowns that cause trouble so we get lots of tests.
   — bob-haller