TL;DR: I canceled my colonoscopy scheduled for tomorrow because the doc’s office never got insurance authorization, despite me nagging them about it at least 4 times.
Insurance is Humana Gold Plus (Medicare Advantage HMO), zip 85003.
I saw a gastroenterologist last Thursday. We scheduled a diagnostic colonoscopy. He had afternoon openings all this week, so I scheduled for tomorrow (Tuesday).
I made sure to tell the assistant on my way out of the office that the procedure was in only 3 business days and that they should obtain an auth right away.
Friday I checked with insurance. No auth requested. They told me one was required, as it was a diagnostic, not routine, colonoscopy. I called the office and left a message about it.
Today I got a call from the surgical center. My share of cost was the entire bill, or about $4200. I asked why and they said that there was no insurance information; and it was the doc office responsibility to obtain authorization, not the surg center.
I called insurance again. No auth on file. Yes, it’s required. I call the doc’s office again. The receptionist says “no auth is required.” I explain diagnostic vs screening colonoscopies, and tell her my insurance said auth is required. They promised they’d take care of it immediately, and call me back within the hour. That was at 2:30pm.
At 4:05 I called them back. The phones were off already even though they don’t close until 5:00 per the recording. I couldn’t even leave a message because the answering service doesn’t take over until 5pm.
I called insurance again meanwhile and they were kind enough to transfer me to the medical auths dept. Was an auth submitted by my doc’s office? No. An employee explained everything in detail. Yes the auth is needed. One big reason why she said is because it’s when the DRGs are determined, which determines payment amount.
She also said that if there was no auth on file when the bill was sent, they would automatically deny payment. And that they would probably pay it after I appealed; or I could pay and submit for reimbursement. But that if the surg center submitted for things insurance wouldn’t cover, that I could be on the hook for those things since no prior auth was given.
After hearing this, I called the answering service and they said all they could do is take a message for call back in the morning.
I then sent the Dr.’s office and the surg center a fax explaining I was canceling the colonoscopy and would reschedule it after insurance authorization was obtained. I also briefly outlined my attempts at getting the office staff to take care of things, the unreturned phone calls, and the phones shut off an hour early.
Wow that was a book. What do you make of this?
submitted by /u/ChucklesManson
[link] [comments]
TL;DR: I canceled my colonoscopy scheduled for tomorrow because the doc’s office never got insurance authorization, despite me nagging them about it at least 4 times. Insurance is Humana Gold Plus (Medicare Advantage HMO), zip 85003. I saw a gastroenterologist last Thursday. We scheduled a diagnostic colonoscopy. He had afternoon openings all this week, so I scheduled for tomorrow (Tuesday). I made sure to tell the assistant on my way out of the office that the procedure was in only 3 business days and that they should obtain an auth right away. Friday I checked with insurance. No auth requested. They told me one was required, as it was a diagnostic, not routine, colonoscopy. I called the office and left a message about it. Today I got a call from the surgical center. My share of cost was the entire bill, or about $4200. I asked why and they said that there was no insurance information; and it was the doc office responsibility to obtain authorization, not the surg center. I called insurance again. No auth on file. Yes, it’s required. I call the doc’s office again. The receptionist says “no auth is required.” I explain diagnostic vs screening colonoscopies, and tell her my insurance said auth is required. They promised they’d take care of it immediately, and call me back within the hour. That was at 2:30pm. At 4:05 I called them back. The phones were off already even though they don’t close until 5:00 per the recording. I couldn’t even leave a message because the answering service doesn’t take over until 5pm. I called insurance again meanwhile and they were kind enough to transfer me to the medical auths dept. Was an auth submitted by my doc’s office? No. An employee explained everything in detail. Yes the auth is needed. One big reason why she said is because it’s when the DRGs are determined, which determines payment amount. She also said that if there was no auth on file when the bill was sent, they would automatically deny payment. And that they would probably pay it after I appealed; or I could pay and submit for reimbursement. But that if the surg center submitted for things insurance wouldn’t cover, that I could be on the hook for those things since no prior auth was given. After hearing this, I called the answering service and they said all they could do is take a message for call back in the morning. I then sent the Dr.’s office and the surg center a fax explaining I was canceling the colonoscopy and would reschedule it after insurance authorization was obtained. I also briefly outlined my attempts at getting the office staff to take care of things, the unreturned phone calls, and the phones shut off an hour early. Wow that was a book. What do you make of this?
submitted by /u/ChucklesManson [link] [comments]Read Morer/HealthInsurance