Re: Insurance Headache/Gloria

[Guest guest]

Hi Gloria, I posted this earlier today but I have'nt seen it yet,so

I'll try again.I spoke with Patrice Lennon(she handles ALL of Dr R's)and she

explained their procedure,here goes.When BCBSNC receives the app for

pre-determination,they process it.It can be approved,denied or CONDITIONAL

approval.(This is important because some underwriters will merely deny and

not stipulate what is needed.) If you have not had an appt with the

referring physician(DrR),BCBSNC will send it back for that.They may also

include other conditions,but you cannot get the final ok until you have seen

the sugeon(DrR).Be sure not to get to wrapped up in the phrase 'referring

physician'.(We think of our PCP as the referring physician but he/she cannot

refer to the insurance,he/she refers you to Dr R and DrR refers you to the

insurance).Only the physician performing the procedure can refer to the

insurance.The bottom line,first you decide if you want it,then the insurance

decides if they'll pay for it,then DrR decides if you are a candidate and if

so,the ins gives the final word for fiscal responsibility.This is not how

all ins does it but that is how BCBSNC explained it to me. Janet

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[Guest guest]

Thanks for the clarification, Janet.

Gloria

> Hi Gloria, I posted this earlier today but I have'nt seen it

yet,so

> I'll try again.I spoke with Patrice Lennon(she handles ALL of Dr

R's)and she

> explained their procedure,here goes.When BCBSNC receives the app

for

> pre-determination,they process it.It can be approved,denied or

CONDITIONAL

> approval.(This is important because some underwriters will merely

deny and

> not stipulate what is needed.) If you have not had an appt with the

> referring physician(DrR),BCBSNC will send it back for that.They may

also

> include other conditions,but you cannot get the final ok until you

have seen

> the sugeon(DrR).Be sure not to get to wrapped up in the phrase

'referring

> physician'.(We think of our PCP as the referring physician but

he/she cannot

> refer to the insurance,he/she refers you to Dr R and DrR refers you

to the

> insurance).Only the physician performing the procedure can refer to

the

> insurance.The bottom line,first you decide if you want it,then the

insurance

> decides if they'll pay for it,then DrR decides if you are a

candidate and if

> so,the ins gives the final word for fiscal responsibility.This is

not how

> all ins does it but that is how BCBSNC explained it to me.

Janet

>

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