Hey all! I’m scheduled for surgery next month and I’m having a really hard time getting clear information from my insurance provider on this topic – everyone I talk to just doesn’t know for some reason.
So I’m scheduled for a septoplasty with a surgeon who does not take insurance. I chose this surgeon and am prepared to pay fully out of pocket, but during previous consults I was told by other in network surgeons that this surgery would be fully covered by my insurance due to my having a severely deviated septum.
The issue I am running into is, from what my insurance has told me, coverage for this surgery requires prior auth, but my surgeon can only provide forms to submit to my insurance after the surgery has been completed (they aren’t going submit for prior auth bc they don’t deal with insurance basically).
I have a PPO plan that allows me to see out of network providers for reimbursement, but not sure what to do since prior auth is needed. Should I try to seek prior auth from an in network ENT? Is that even a logical thing to try? My surgeon’s office didn’t have any suggestions and the insurance agents haven’t been able to tell me anything other than my plan just says prior auth is needed for that surgery. Any help is appreciated, thanks!
submitted by /u/raraokay
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Hey all! I’m scheduled for surgery next month and I’m having a really hard time getting clear information from my insurance provider on this topic – everyone I talk to just doesn’t know for some reason. So I’m scheduled for a septoplasty with a surgeon who does not take insurance. I chose this surgeon and am prepared to pay fully out of pocket, but during previous consults I was told by other in network surgeons that this surgery would be fully covered by my insurance due to my having a severely deviated septum. The issue I am running into is, from what my insurance has told me, coverage for this surgery requires prior auth, but my surgeon can only provide forms to submit to my insurance after the surgery has been completed (they aren’t going submit for prior auth bc they don’t deal with insurance basically). I have a PPO plan that allows me to see out of network providers for reimbursement, but not sure what to do since prior auth is needed. Should I try to seek prior auth from an in network ENT? Is that even a logical thing to try? My surgeon’s office didn’t have any suggestions and the insurance agents haven’t been able to tell me anything other than my plan just says prior auth is needed for that surgery. Any help is appreciated, thanks!
submitted by /u/raraokay [link] [comments]Read Morer/HealthInsurance