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Insurance Question… Pre-Approval?
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Insurance Question… Pre-Approval?

› Forums › General Melanoma Community › Insurance Question… Pre-Approval?

  • Post
    • May 13, 2014 at 6:33 pm
    kpcollins31
    Participant

      Just curious how many of you seek "pre-approval" of certain procedures through your health insurance carriers. I have good insurance so I never really thought about it – if a doctor tells me to have a CT or a PET scan, I just do it. Same with surgery. My thought has always been that I will not let some bureaucrat dictate what treatments I should or should not have as that is a choice for me and my doctor. If the insurance denies something, I can deal with it afterwards. For example, they recently deemed general anesthesia and an epidural as "not medically necessary" for open abdominal surgery which I thought was kind of funny… we got that fixed.

      I ask the general question because my PET scan is coming up next week and I received the letter from the hospital stating that I should ensure that I am preapproved by my insurance prior to showing up for the appointment.

      Kevin

         

    Viewing 11 reply threads
    • Replies
        • May 13, 2014 at 7:41 pm
        G-Samsa
        Participant

          I have good insurance too — but I wouldn't want to go into a costly procedure ( where pre-approval is required) without the pre- approval.  I can't see how fighting the fight after the fact puts you in a stronger position –better to deal with it as the hospital recommends. You certainly can't claim ignorance of the requirement.

          • May 13, 2014 at 7:41 pm
          G-Samsa
          Participant

            I have good insurance too — but I wouldn't want to go into a costly procedure ( where pre-approval is required) without the pre- approval.  I can't see how fighting the fight after the fact puts you in a stronger position –better to deal with it as the hospital recommends. You certainly can't claim ignorance of the requirement.

            • May 13, 2014 at 7:41 pm
            G-Samsa
            Participant

              I have good insurance too — but I wouldn't want to go into a costly procedure ( where pre-approval is required) without the pre- approval.  I can't see how fighting the fight after the fact puts you in a stronger position –better to deal with it as the hospital recommends. You certainly can't claim ignorance of the requirement.

              • May 13, 2014 at 7:42 pm
              kylez
              Participant

                Kevin,

                Both of the facilities I go to handle getting approvals from the (PPO) insurance company for me. I've yet to interact directly with an insurance company in the 3+ years I've been doing this. Maybe it's the PPO aspect that makes this easier for the hospital to handle directly?

                  • May 14, 2014 at 11:42 am
                  tschmith
                  Participant

                    I always make sure surgeries, MRIs, scans, and so on are pre-approved.  I take the authorization number with me just in case there's a mix-up.  So far, I haven't had any problems with coverage.

                     

                    • May 14, 2014 at 11:42 am
                    tschmith
                    Participant

                      I always make sure surgeries, MRIs, scans, and so on are pre-approved.  I take the authorization number with me just in case there's a mix-up.  So far, I haven't had any problems with coverage.

                       

                      • May 14, 2014 at 11:42 am
                      tschmith
                      Participant

                        I always make sure surgeries, MRIs, scans, and so on are pre-approved.  I take the authorization number with me just in case there's a mix-up.  So far, I haven't had any problems with coverage.

                         

                      • May 13, 2014 at 7:42 pm
                      kylez
                      Participant

                        Kevin,

                        Both of the facilities I go to handle getting approvals from the (PPO) insurance company for me. I've yet to interact directly with an insurance company in the 3+ years I've been doing this. Maybe it's the PPO aspect that makes this easier for the hospital to handle directly?

                        • May 13, 2014 at 7:42 pm
                        kylez
                        Participant

                          Kevin,

                          Both of the facilities I go to handle getting approvals from the (PPO) insurance company for me. I've yet to interact directly with an insurance company in the 3+ years I've been doing this. Maybe it's the PPO aspect that makes this easier for the hospital to handle directly?

                          • May 14, 2014 at 6:15 pm
                          adriana cooper
                          Participant

                            We're on the pre-approval side so there are no surprises as we don't have anywhere near the funds to cover these procedures. WE just received our copy of the bill for the PET/CT and MRI at just under $20k. Initially denied just two days before the scans that required a phone consult to them from the Dr. Also initially denied was an overnight stay in the hospital following lung surgery, that would be requiring a chest tube, (did they really think she was going home with that in her?) That required a phone call post surgery to authorize. The patient rep at the hospital indicated that these types of calls were not uncommon these days. She handled the necessary calls. Haven't seen this bill yet but I suspect it will be tens of thousands $. Obviously health comes far before moneybut the health care industry is a business and it does indeed  put a dollar amount on our lives.

                            Rob

                            • May 14, 2014 at 6:15 pm
                            adriana cooper
                            Participant

                              We're on the pre-approval side so there are no surprises as we don't have anywhere near the funds to cover these procedures. WE just received our copy of the bill for the PET/CT and MRI at just under $20k. Initially denied just two days before the scans that required a phone consult to them from the Dr. Also initially denied was an overnight stay in the hospital following lung surgery, that would be requiring a chest tube, (did they really think she was going home with that in her?) That required a phone call post surgery to authorize. The patient rep at the hospital indicated that these types of calls were not uncommon these days. She handled the necessary calls. Haven't seen this bill yet but I suspect it will be tens of thousands $. Obviously health comes far before moneybut the health care industry is a business and it does indeed  put a dollar amount on our lives.

                              Rob

                              • May 14, 2014 at 6:15 pm
                              adriana cooper
                              Participant

                                We're on the pre-approval side so there are no surprises as we don't have anywhere near the funds to cover these procedures. WE just received our copy of the bill for the PET/CT and MRI at just under $20k. Initially denied just two days before the scans that required a phone consult to them from the Dr. Also initially denied was an overnight stay in the hospital following lung surgery, that would be requiring a chest tube, (did they really think she was going home with that in her?) That required a phone call post surgery to authorize. The patient rep at the hospital indicated that these types of calls were not uncommon these days. She handled the necessary calls. Haven't seen this bill yet but I suspect it will be tens of thousands $. Obviously health comes far before moneybut the health care industry is a business and it does indeed  put a dollar amount on our lives.

                                Rob

                                • May 14, 2014 at 7:24 pm
                                kpcollins31
                                Participant

                                  I appreciate the responses – they made me a little nervous so I called my insurance provider to get details on what is required. I was told that for my insurance (Blue Cross Blue Shield PPO), the only procedures requiring pre-approval would be in-patient procedures but they indicated that the doctor/hospital handles that pre-approval. For scans and such no preapproval would be required.  

                                  Kevin

                                   

                                  • May 14, 2014 at 7:24 pm
                                  kpcollins31
                                  Participant

                                    I appreciate the responses – they made me a little nervous so I called my insurance provider to get details on what is required. I was told that for my insurance (Blue Cross Blue Shield PPO), the only procedures requiring pre-approval would be in-patient procedures but they indicated that the doctor/hospital handles that pre-approval. For scans and such no preapproval would be required.  

                                    Kevin

                                     

                                    • May 14, 2014 at 7:24 pm
                                    kpcollins31
                                    Participant

                                      I appreciate the responses – they made me a little nervous so I called my insurance provider to get details on what is required. I was told that for my insurance (Blue Cross Blue Shield PPO), the only procedures requiring pre-approval would be in-patient procedures but they indicated that the doctor/hospital handles that pre-approval. For scans and such no preapproval would be required.  

                                      Kevin

                                       

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