I recently noticed that my doctors office failed to pre-authorize claims for a special medication even though they were aware it required pre-authorization. Cigna’s document states that if it’s an in-network provider they are responsible for the pre-auth. The EOB states ” A2 – THESE BENEFITS WERE REDUCED DUE TO FAILURE TO OBTAIN PRE-CERTIFICATION APPROVAL AS OUTLINED IN THE PLAN. THIS AMOUNT REPRESENTS DOLLARS ASSOCIATED WITH THE PRE-CERTIFICATION NOT OBTAINED FOR THE SERVICES RENDERED. THE PROVIDER IS PROHIBITED FROM BILLING THE PATIENT FOR THIS AMOUNT. IF YOU HAVE ALREADY PAID THIS AMOUNT,PLEASE REQUEST REIMBURSEMENT FROM YOUR PROVIDER. “
Since this is their mistake and based on Cigna’s documentation I do not believe I would be financially liable for this amount. Has anyone ran into this before and am I as safe as I think I am?
submitted by /u/jacobt777
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I recently noticed that my doctors office failed to pre-authorize claims for a special medication even though they were aware it required pre-authorization. Cigna’s document states that if it’s an in-network provider they are responsible for the pre-auth. The EOB states ” A2 – THESE BENEFITS WERE REDUCED DUE TO FAILURE TO OBTAIN PRE-CERTIFICATION APPROVAL AS OUTLINED IN THE PLAN. THIS AMOUNT REPRESENTS DOLLARS ASSOCIATED WITH THE PRE-CERTIFICATION NOT OBTAINED FOR THE SERVICES RENDERED. THE PROVIDER IS PROHIBITED FROM BILLING THE PATIENT FOR THIS AMOUNT. IF YOU HAVE ALREADY PAID THIS AMOUNT,PLEASE REQUEST REIMBURSEMENT FROM YOUR PROVIDER. ” Since this is their mistake and based on Cigna’s documentation I do not believe I would be financially liable for this amount. Has anyone ran into this before and am I as safe as I think I am?
submitted by /u/jacobt777 [link] [comments]Read Morer/HealthInsurance