Hello everyone! First time poster, and in hoping y’all can maybe give me some tips.
I don’t think my income or zip code is relevant since I already have the plan and am not looking, but I’m 25. If mods think otherwise, or that’s a hard and fast rule regardless, please let me know.
I have BCBS IL. I need to have a procedure done, and my doctor sent in a pre-auth, stating that the code he’s been using has been approved by BCBS specifically recently and that he has high hopes.
I called insurance to ask about pre-auth and the code, and was told the code I provided in an out-latiwnt, office setting (which it will be) should be auto-approved/covered with no need for pre auth.
I called a week or so later to check my pre-auth status, and was told the same thing. And that it may come back as “no approval needed” BECAUSE it’s auto-approved. Well ok, cool.
I wait another week and find the claim is currently denied until they can do a peer to peer with my doctor. That’s fine, I’m used to that sort of thing.
But when I called in to find out the reason behind the denial (and the subsequent peer to peer) I asked about the auto-approved thing and the employee sounded utterly confused and said she knew of no such thing. That pre-auth was definitely needed.
Now I’m just concerned about the info I’m given because obviously the first two were incorrect, right? Is there anything I can do to ensure the info I receive is correct? I don’t know who to believe. And I don’t know if I’d be a jerk for calling and, say, asking for a manager or something.
Do I have any actual course of action I can follow here to make sure I’m not being continually misinformed.
submitted by /u/Oisillion
[link] [comments]
Hello everyone! First time poster, and in hoping y’all can maybe give me some tips. I don’t think my income or zip code is relevant since I already have the plan and am not looking, but I’m 25. If mods think otherwise, or that’s a hard and fast rule regardless, please let me know. I have BCBS IL. I need to have a procedure done, and my doctor sent in a pre-auth, stating that the code he’s been using has been approved by BCBS specifically recently and that he has high hopes. I called insurance to ask about pre-auth and the code, and was told the code I provided in an out-latiwnt, office setting (which it will be) should be auto-approved/covered with no need for pre auth. I called a week or so later to check my pre-auth status, and was told the same thing. And that it may come back as “no approval needed” BECAUSE it’s auto-approved. Well ok, cool. I wait another week and find the claim is currently denied until they can do a peer to peer with my doctor. That’s fine, I’m used to that sort of thing. But when I called in to find out the reason behind the denial (and the subsequent peer to peer) I asked about the auto-approved thing and the employee sounded utterly confused and said she knew of no such thing. That pre-auth was definitely needed. Now I’m just concerned about the info I’m given because obviously the first two were incorrect, right? Is there anything I can do to ensure the info I receive is correct? I don’t know who to believe. And I don’t know if I’d be a jerk for calling and, say, asking for a manager or something. Do I have any actual course of action I can follow here to make sure I’m not being continually misinformed.
submitted by /u/Oisillion [link] [comments]Read Morer/HealthInsurance