--PreCert vs. PreAuth

[Guest guest]

~

I thought I had a handle on these two terms as it applies to insurance,

but after my conversation with the insurance company today, I'm not so sure.

Could you help me understand the nuances here? Do the meanings differ

from ins. co. to another?

Okay, here is another question...it begins with what you sent earlier

about insurance....

>(2) See if the hospital bill and anaesthesia are covered anyway.

>Sometimes, even though the surgery itself ( " weight loss surgery " ) is

>excluded, when you have to be hospitalized, your insurance policy will

>cover the hospital bill and maybe even the anesthesia bill. This is the

>*major* part of the expense. The surgery bill is $4,000 (and you get a

>discount if you pay cash, so I think it is $3,200 in that case), but the

>hospital bill is about $9,000 and the anesthesia is another $1,000. If

>your policy pays the hospitalization, alone, that would be $9,000 you

>don't have to pay. Again, find out if your policy will cover the

>hospital bills. Just like they will pay for your physical before

>surgery and medicines that you need after the surgery, they may very

>well pay the hospital bill and even the anesthesia bill, even when

> " weight loss surgery " is excluded in your policy

My policy says...under exclusions....

" Charges for services or supplies furnished for weight reduction or in

connection with morbid obesity. "

If I read that right...they pretty much covered their hind-ends, right?

I can't even get them to cover the hospital bill or anesthesia, because

that is services/supplies IN CONNECTION with morbid obestity. Isn't

that correct? BUT, what if it has been deemed that this surgery is

" medically necessary " and it is pre-certified? I was told I was

pre-certified b/c of medical necessity, but that was not a guarantee of

payment. So what does pre-certification do for me if it doesn't mean

they'll pay??

Please help!

Tricia in IL

confuzzled MGB wannabe