Re: insurance coverage

[Guest guest]

My insurance (and I think most insurance plans) REQUIRE a

pre-certification or prior approval before any hospital admission or

hospital procedure, with the exception of those done in an emergency.

On my plan, even emergency procedures must be certified within 24 hours

of admission.

Carol

__________________________________________________

[Guest guest]

My insurance (and I think most insurance plans) REQUIRE a

pre-certification or prior approval before any hospital admission or

hospital procedure, with the exception of those done in an emergency.

On my plan, even emergency procedures must be certified within 24 hours

of admission.

Carol

__________________________________________________

[Guest guest]

My insurance (and I think most insurance plans) REQUIRE a

pre-certification or prior approval before any hospital admission or

hospital procedure, with the exception of those done in an emergency.

On my plan, even emergency procedures must be certified within 24 hours

of admission.

Carol

__________________________________________________

[Guest guest]

In my case I have no choice, my doctor's office won't do any surgery until I

get pre-approval. The good thing is my health insurance has allocated 25,000

dollars for me and my husband for infertility treatments. Since I have had

two miscarriages and no children, all of my procedures are viewed as

infertility treatments. Sometimes there is no choice in pre-approval or not,

it depends on how your doctor's office files, if they file for you. If you

file for yourself then you get to make the call.

Dana

[Guest guest]

In my case I have no choice, my doctor's office won't do any surgery until I

get pre-approval. The good thing is my health insurance has allocated 25,000

dollars for me and my husband for infertility treatments. Since I have had

two miscarriages and no children, all of my procedures are viewed as

infertility treatments. Sometimes there is no choice in pre-approval or not,

it depends on how your doctor's office files, if they file for you. If you

file for yourself then you get to make the call.

Dana

[Guest guest]

In my case I have no choice, my doctor's office won't do any surgery until I

get pre-approval. The good thing is my health insurance has allocated 25,000

dollars for me and my husband for infertility treatments. Since I have had

two miscarriages and no children, all of my procedures are viewed as

infertility treatments. Sometimes there is no choice in pre-approval or not,

it depends on how your doctor's office files, if they file for you. If you

file for yourself then you get to make the call.

Dana

[Guest guest]

Having worked in the (awful) managed care business, I suggest that

you follow all of their requirements to the letter. Dot the i's,

cross the t's. It's a huge, messy bureaucracy, and the only way to

handle it is to do exactly what they tell you to do. Don't give them

any opportunity to say, " you didn't follow procedure! " Definately do

pre-certification of any hospital admission. Start it well in

advance if possible because sometimes (especially with " female

problems " ) there is a bunch of red tape to get through (certain

diagnosis and procedures send up automatic red flags in their

computer systems). Most doctor's offices makes these calls for you,

but I would ask them to be sure. good luck! Lara

p.s. managed care is a pain, but in its defense I have to say it

does stop some unnecessary hysterectomies.

[Guest guest]

Not sure which way to go either. Called my insurance co. today regarding

coverage for a UAE. Was told they couldn't tell me this ....needed a code

from the doctor/surgeon ordering the UAE. Makes no sense to me. Somethings

amiss.

[Guest guest]

The codes they are talking about are " procedure codes " . I know because in

January, when I was first checking into UAE, I called the insurance company and

was told I needed the procedure codes for them to tell me if it was covered.

I e-mailed an IR in my area to ask what the procedure codes were (just found an

IR from the SCVIR site that had e-mail and was in my area, turns out I did use

that IR to do my procedure in April). He sent them, I called the insurance

company back and they told me they were covered. They are now denying coverage

after the procedure.

Make sure you keep records of the dates, times and who you speak with at the

insurance company, even on calls like these. For me it is providing me

amunition for my appeal.

Ann

[Guest guest]

The codes they are talking about are " procedure codes " . I know because in

January, when I was first checking into UAE, I called the insurance company and

was told I needed the procedure codes for them to tell me if it was covered.

I e-mailed an IR in my area to ask what the procedure codes were (just found an

IR from the SCVIR site that had e-mail and was in my area, turns out I did use

that IR to do my procedure in April). He sent them, I called the insurance

company back and they told me they were covered. They are now denying coverage

after the procedure.

Make sure you keep records of the dates, times and who you speak with at the

insurance company, even on calls like these. For me it is providing me

amunition for my appeal.

Ann