Question:
I Had precertifications, now insurance not paying?
Help: I had a primary and secondary insurance at the time of my surgery. The doctors office told me that they had recieved a precertification from both insurance companies. My primary has paid the $30,000 lifetime maxium for anything related to morbid obesity. SO, I assume my secondary would pay the last $10,000. I received an explanation of benefits from them today (of course on a saturday!!) and it says "these items not a covered benefit" Anyone out there with insurance background can speak to this? I am scared out of my mind that I might owe the $10,000. I don't have it!! Isn't a precertification that my doctors office told me they had enough for the secondary to have to pay? (I will call on Monday, but I am totally stressing right now!) Thanks!! — Karen A. (posted on February 9, 2002)
February 9, 2002
A precertification does not necessarily indicate a "preapproval"
to go ahead and have surgery, but it sounds like you have documentation
that the insurance company had intention of paying for the surgery before
you had it. (?) Have you talked with the insurance company yet? I bet you
could negotiate something. Worse-case scenario, I'm sure the surgeon would
let you work out some kind of a payment plan, especially since he's already
performed the surgery and he has no option.
— Terissa R.
February 9, 2002
I had pre certification on a surgery that one of my children had. It was
necessary to correct a birth defect. After the surgery was done the ins.
co. refused to pay! My Doctor told me it was his problem not mine , and
that he would take care of it or eat the charges. But I still had the
hospital bill. I called the state insurence commissioner and they took it
from there.
— Rose A.
February 9, 2002
If your secondary carrier did indeed precertify your WLS, acquire that
written documentation from your surgeon and follow-up accordingly with
management. If they didn't precertify it and it is not a covered benefit,
you will be liable.
— JoanneML
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