Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Email and call both!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Email and call both!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Cathy, Dr. R gets a pre-authorization before the pre-certification. You need to call back and ask for the department that does the pre-authorizations. This is where they review to see if they feel the procedure is medically necessary and if you qualify under thier criteria. Then if you are approved, Debbie can go ahead and give them a surgery date and get you a pre-cert. Sorry just more red tape. > Hi, > Well, I called United Healthcare, but I'm still lost. The person I talked > to wanted to know what my surgery date was, I told them it hadn't been set > yet as I was waiting for approval. He said that there was no approval showing > up in the computer, but he said that Dr. R or his office would have to call > them as that is the way they approve is by phone call from my Doctor or I > guess the office to them. Now what do I do? Do I email Debbie and tell her > this? Will they make the call do you think? > > Cathy in Lenoir, NC > Wanting to be on the other side > BMI 42 > Patient info emailed 5/2/00 > A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Cathy, Dr. R gets a pre-authorization before the pre-certification. You need to call back and ask for the department that does the pre-authorizations. This is where they review to see if they feel the procedure is medically necessary and if you qualify under thier criteria. Then if you are approved, Debbie can go ahead and give them a surgery date and get you a pre-cert. Sorry just more red tape. > Hi, > Well, I called United Healthcare, but I'm still lost. The person I talked > to wanted to know what my surgery date was, I told them it hadn't been set > yet as I was waiting for approval. He said that there was no approval showing > up in the computer, but he said that Dr. R or his office would have to call > them as that is the way they approve is by phone call from my Doctor or I > guess the office to them. Now what do I do? Do I email Debbie and tell her > this? Will they make the call do you think? > > Cathy in Lenoir, NC > Wanting to be on the other side > BMI 42 > Patient info emailed 5/2/00 > A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Cathy, Dr. R gets a pre-authorization before the pre-certification. You need to call back and ask for the department that does the pre-authorizations. This is where they review to see if they feel the procedure is medically necessary and if you qualify under thier criteria. Then if you are approved, Debbie can go ahead and give them a surgery date and get you a pre-cert. Sorry just more red tape. > Hi, > Well, I called United Healthcare, but I'm still lost. The person I talked > to wanted to know what my surgery date was, I told them it hadn't been set > yet as I was waiting for approval. He said that there was no approval showing > up in the computer, but he said that Dr. R or his office would have to call > them as that is the way they approve is by phone call from my Doctor or I > guess the office to them. Now what do I do? Do I email Debbie and tell her > this? Will they make the call do you think? > > Cathy in Lenoir, NC > Wanting to be on the other side > BMI 42 > Patient info emailed 5/2/00 > A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 19, 2000 Report Share Posted June 19, 2000 Cathy, Make sure they understand that you are calling regarding pre-approval (sometimes called pre-authorization) NOT pre-certification. Sounds like from what they told you that they think you mean pre-cert (that's what the insurance industry calls it when you have to let them know you have been hospitalized--just certifying the hospital stay--it has nothing to do with prior approval). It's kinda confusing, I know. Of course, if your surgery isn't approved, neither will your hospital stay be covered. If you get the run around, don't let them put you off. Ask for a supervisor. Be prepared for the customer service rep to try to talk you out of it; they probably get written up for it. I used to be a CSR in a call center for a health insurance company and we were " strongly advised " not to transfer an insured member to a supervisor. You may also be told they will have the supervisor call you back; if you don't get a call back within 24 hours, call again. But many times a CSRs hands are tied and they CAN'T tell you anything. A supervisor, however, can get things done (if he or she is at all customer oriented). Good Luck! XXXOOO (also in NC--not far from you!) > Hi, > Well, I called United Healthcare, but I'm still lost. The person I talked > to wanted to know what my surgery date was, I told them it hadn't been set > yet as I was waiting for approval. He said that there was no approval showing > up in the computer, but he said that Dr. R or his office would have to call > them as that is the way they approve is by phone call from my Doctor or I > guess the office to them. Now what do I do? Do I email Debbie and tell her > this? Will they make the call do you think? > > Cathy in Lenoir, NC > Wanting to be on the other side > BMI 42 > Patient info emailed 5/2/00 > A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
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