Ins will not do Pre-Certification

kjm205
on 6/1/16 6:55 am - Pittsburgh, PA

Anyone else have an insurance company that didn't do pre-certifications? I have Carefirst Blue Cross out of Maryland and they will not do a pre-cert. They will only accept or deny coverage AFTER the fact when the bill is submitted. I am terrified to have a pannilectomy and then not have it covered. Anyone else have this happen??? 

(deactivated member)
on 6/1/16 7:21 am
ReShape on 10/30/16

Wow this is scary and feels very much like a roll of the dice. I hope someone from Maryland with your same coverage can shed some light. Good Luck!

hollykim
on 6/1/16 2:00 pm - Nashville, TN
Revision on 03/18/15
On June 1, 2016 at 1:55 PM Pacific Time, kjm205 wrote:

Anyone else have an insurance company that didn't do pre-certifications? I have Carefirst Blue Cross out of Maryland and they will not do a pre-cert. They will only accept or deny coverage AFTER the fact when the bill is submitted. I am terrified to have a pannilectomy and then not have it covered. Anyone else have this happen??? 

I personally would not do it without a precert.

 


          

 

Sharon SW-267
GW-165 CW-167 S.

on 6/2/16 12:33 pm - PA
RNY on 12/22/14

Is the NO Precert stated in your policy - have you actullay seen it in writing, or just what some rep told you.  It sounds strange, but I do not know anything about MD.  I have a NJ Blue Cross plan and I found the Pre-cert process, just by goggling on line. 

It looks like Carefirst calls it "preauthorization" - this link may not be for your exact policy, but you should be able to find it for your policy. 

https://provider.carefirst.com/providers/medical/in-network- precertification-preauthorization.page

I saw some on-line posts saying what you said about no-precerts, but it just sounds odd. 

But, your surgeon would submit the package for per-cert, what does their ins expert say?  They have prob run into this before.

Sharon

NYMom222
on 6/3/16 7:09 pm
RNY on 07/23/14

Yes the question would be, Do they do this for all surgeries? Also you can ask what are the guidelines they use to determine coverage? Most insurance companies it involves 'medical necessity' which means documented rashes, infections etc....

Cynthia 5'11" RNY 7/23/2014

Goal reached 17 months. 220lb Weight Loss
Plastic Surgery Dr. Joseph Michaels - LBL and Hernia Repair 2/29/16, Arm Lift, BL, 5/2/16, Leg Lift 7/25/16

#lifeisanadventure #fightthegoodfight #noregrets

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