I’m going to be extremely vulnerable here, but I need help and advice. I am a female to male transgender person and I have a hysto scheduled on 4/11/22. Gender dysphoria and hormone/surgical treatments like hystos are covered in my policy. I do however need two mental health eval letters that my insurance policy says I need to supply with my claim (one, is more detailed than the other. Nevertheless, both state they recommend the surgery). So my surgery scheduler put in the pre-auth request with my insurance company. My insurance company git back to her that I do not need pre-auth for this procedure. They said they do not recommend doing a pre-determination either since, according to them, this is a covered procedure and should not need review. Does that sound suspicious to anyone? I asked if we could still do the pre-determination because I feel very uneasy walking into this surgery thinking “oh well the insurance company says it will be covered, so I should be fine” and then get stuck with a 50K bill 4 months later because the insurance company didn’t like my letters or something.
I requested that my surgery scheduler completed the pre-determination to help put my mind at ease, but even then if they approve that, I’m still worried that the insurance company will back out after the fact even if they approve the predetermination. My surgery scheduler says that if that were to happen they would file an appeal and my doctor would help fight it, but at the end of the day insurance companies hold all the power and make the final decisions. I recorded a call (more for my benefit in case I forget info about the claims process) and the lady said she “honestly couldn’t see my claim being denied” but also said they can’t confirm coverage until a claim is submitted. Is there anything else I should be doing? Or am I just being a little too paranoid?
submitted by /u/elikjaycon
[link] [comments]I’m going to be extremely vulnerable here, but I need help and advice. I am a female to male transgender person and I have a hysto scheduled on 4/11/22. Gender dysphoria and hormone/surgical treatments like hystos are covered in my policy. I do however need two mental health eval letters that my insurance policy says I need to supply with my claim (one, is more detailed than the other. Nevertheless, both state they recommend the surgery). So my surgery scheduler put in the pre-auth request with my insurance company. My insurance company git back to her that I do not need pre-auth for this procedure. They said they do not recommend doing a pre-determination either since, according to them, this is a covered procedure and should not need review. Does that sound suspicious to anyone? I asked if we could still do the pre-determination because I feel very uneasy walking into this surgery thinking “oh well the insurance company says it will be covered, so I should be fine” and then get stuck with a 50K bill 4 months later because the insurance company didn’t like my letters or something. I requested that my surgery scheduler completed the pre-determination to help put my mind at ease, but even then if they approve that, I’m still worried that the insurance company will back out after the fact even if they approve the predetermination. My surgery scheduler says that if that were to happen they would file an appeal and my doctor would help fight it, but at the end of the day insurance companies hold all the power and make the final decisions. I recorded a call (more for my benefit in case I forget info about the claims process) and the lady said she “honestly couldn’t see my claim being denied” but also said they can’t confirm coverage until a claim is submitted. Is there anything else I should be doing? Or am I just being a little too paranoid? submitted by /u/elikjaycon [link] [comments]Read Morer/HealthInsurance