My insurance company, Cigna, recently revised a policy document so that some procedures there were previously maybe covered, are now covered, but “may be considered medically necessary pending a case-by-case review by a medical director…”.
My understanding is that a medical director is just a doctor hired by the insurance company to review the prior authorization and say yea or nay. Is this different from the normal approval process? Would I have to do anything to access these procedures differently than for most other things; i.e. talking to my doctor and having them get prior authorization from the insurance company? Do I need to just get the procedure and then try to seek reimbursement later?
I really don’t want to do something out of order and get screwed out of coverage!
I believe it’s also possible to fight denials of coverage, but it seems like that becomes a legal battle at that point.
submitted by /u/danfish_77
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My insurance company, Cigna, recently revised a policy document so that some procedures there were previously maybe covered, are now covered, but “may be considered medically necessary pending a case-by-case review by a medical director…”. My understanding is that a medical director is just a doctor hired by the insurance company to review the prior authorization and say yea or nay. Is this different from the normal approval process? Would I have to do anything to access these procedures differently than for most other things; i.e. talking to my doctor and having them get prior authorization from the insurance company? Do I need to just get the procedure and then try to seek reimbursement later? I really don’t want to do something out of order and get screwed out of coverage! I believe it’s also possible to fight denials of coverage, but it seems like that becomes a legal battle at that point.
submitted by /u/danfish_77 [link] [comments]Read Morer/HealthInsurance