Question:
Authorization but no approval

Has anyone had their insurance company tell you that you have an authorization, but no approval yet?    — Kristin R. (posted on August 7, 2001)

August 7, 2001
Most insurance companies only give an authorization number for the surgery. I guess that is sort of their way of telling you that it is covered under your plan, but it still gives them an out if they want to not cover it later. My doctor went ahead and set a surgery date with just the authorization number from my two insurances, so I guess it is good enough for them! I am a month post-op and my first insurance has already paid their part, so waiting on the second to pay now. Call your surgeon and get your date set today, and good luck to you!
   — gina P.

August 8, 2001
As far as you are concerned the "authorization" is your "approval". The doc/hospital get the auth number and they know that the insr has approved the procedure. But! Most insurers have a clause that says "authorization does not guarantee payment". That means that if the doc/hospital don't submit the claims correctly they won't get paid even with an authorizaion.....and if that happens they can't bill you for their "mistakes". Also even when insurers "authorize" surgical procedures they sometimes don't actually pay the hospitals. They ask for copies of the medical record (3-4 times), they audit the charges, they "have not record" of the auth number.....yada yada yada. But, as long as you have the authorizaion you are protected.
   — [Anonymous]

August 8, 2001
I was told that this is just as good as the approval. I panicked because mine also said NO PAYMENT GUARANTEED
   — Annette W.

August 8, 2001
I was told that this is just as good as the approval. I panicked because mine also said NO PAYMENT GUARANTEED and I thought oh WOW they are not going to accept that, but they did. I am just NOW getting excited that everything is fine and my surgery date is set. (Aug22)
   — Annette W.