insurance woes - no preapproval

[Guest guest]

Hello all,

I haven't posted in awhile as I've been busy at college. I am trying

to endure the long and painful process of dealing with insurance

companies. Has anyone delt with policies that do not preapprove

surgery, but approve it AFTER you've had it? That means that if they

don't approve it, you're $30,000 in the hole (at least in my case). It

is a very high risk. By the way, I have Blue Cross Blue Shield through

my parents, as I am still in college. We are very worried that the

insurance company won't view the surgery as a medical necessity because

I'm not on any pain medication (although I have some pain) and it seems

as if I don't need it YET. Anyone have any clue how this works? I'd

greatly appreciate any advice.

[Guest guest]

I have Blue Cross also. I have the PPO not the HMO, and I had to get

a preapproval. I was not on any type of pain medication. You never

know what insurance companies are going to do, so I would hate to

say that you should have no problem with Blue Cross, but I have not

had any problems with them yet.

> Hello all,

>

> I haven't posted in awhile as I've been busy at college. I am

trying

> to endure the long and painful process of dealing with insurance

> companies. Has anyone delt with policies that do not preapprove

> surgery, but approve it AFTER you've had it? That means that if

they

> don't approve it, you're $30,000 in the hole (at least in my

case). It

> is a very high risk. By the way, I have Blue Cross Blue Shield

through

> my parents, as I am still in college. We are very worried that

the

> insurance company won't view the surgery as a medical necessity

because

> I'm not on any pain medication (although I have some pain) and it

seems

> as if I don't need it YET. Anyone have any clue how this works?

I'd

> greatly appreciate any advice.

>

>

[Guest guest]

Hi ,

My insurance company does not have a pre-authorization policy

either. They say the same thing, " if it is medically necessary, it

is covered " . I was told by a representative, that they will still

preauthorize, but you have to keep at them. You are right, if you

just go ahead, and they deny, it is more difficult for you to get it

approved post op, and they will question everything about the

procedure. That could leave you on the hook for the expense, more

than you should be. So get it pre authorized that it is medically

necessary and a covered procedure at least. Ask you surgeon's

insurance office to help you with this. That will give you some

teeth post op if there is a problem with them saying it is not a

medically necessary procedure, or that it is excluded from your

particular policy. I hope this helps!

Fran

> Hello all,

>

> I haven't posted in awhile as I've been busy at college. I am

trying

> to endure the long and painful process of dealing with insurance

> companies. Has anyone delt with policies that do not preapprove

> surgery, but approve it AFTER you've had it? That means that if

they

> don't approve it, you're $30,000 in the hole (at least in my

case). It

> is a very high risk. By the way, I have Blue Cross Blue Shield

through

> my parents, as I am still in college. We are very worried that

the

> insurance company won't view the surgery as a medical necessity

because

> I'm not on any pain medication (although I have some pain) and it

seems

> as if I don't need it YET. Anyone have any clue how this works?

I'd

> greatly appreciate any advice.

>

>

[Guest guest]

Hey ,

I'm also a college student, and I had major problems with my

insurance situation as well. My insurance company, Keystone, ended

up not approving the surgery, and what's even more frustrating is

that it took them 4 months just to tell me that they don't cover this

type of surgery. Now I may have to pay for this surgery by myself

since my surgery is coming up soon. So don't make the same mistake I

did. Make sure you find out either yourself or from your surgeon's

office if your insurance company has a history of approving or not

approving this type of surgery. You want to get this insurance

process started and finish as fast as possible.

Jae

> Hello all,

>

> I haven't posted in awhile as I've been busy at college. I am

trying

> to endure the long and painful process of dealing with insurance

> companies. Has anyone delt with policies that do not preapprove

> surgery, but approve it AFTER you've had it? That means that if

they

> don't approve it, you're $30,000 in the hole (at least in my

case). It

> is a very high risk. By the way, I have Blue Cross Blue Shield

through

> my parents, as I am still in college. We are very worried that the

> insurance company won't view the surgery as a medical necessity

because

> I'm not on any pain medication (although I have some pain) and it

seems

> as if I don't need it YET. Anyone have any clue how this works?

I'd

> greatly appreciate any advice.

>

>

[Guest guest]

Jae,

I'm not sure if it's the same for your program, or even if you need

this information, but my student loan package was adjusted to cover

the cost of my braces. Any extraneous medical / dental expenses can

warrant an appeal for extra funding, as well as emergency expenses

like car repairs or even a one-time computer purchase. If it comes

down to having to come out of your own pocket, I'd ask your financial

aid advisor if they can help you out at all. I had to do it because

I'm living completely on student loans - vet school doesn't give me

much time to work! And since I got it prior to consolidating

everything I have up till now, before the interest rate goes up July

1st, it's not really going to cost me too much more to finance it

that way.

Kate

> > Hello all,

> >

> > I haven't posted in awhile as I've been busy at college. I am

> trying

> > to endure the long and painful process of dealing with insurance

> > companies. Has anyone delt with policies that do not preapprove

> > surgery, but approve it AFTER you've had it? That means that if

> they

> > don't approve it, you're $30,000 in the hole (at least in my

> case). It

> > is a very high risk. By the way, I have Blue Cross Blue Shield

> through

> > my parents, as I am still in college. We are very worried that

the

> > insurance company won't view the surgery as a medical necessity

> because

> > I'm not on any pain medication (although I have some pain) and it

> seems

> > as if I don't need it YET. Anyone have any clue how this works?

> I'd

> > greatly appreciate any advice.

> >

> >

[Guest guest]

Hi , I have Blue Cross/Blue Shield of California ad they

approved it with out any problems. I just had surgery and was able

to view my claims on line and they paid even more than it was

expected. I have the PPO plan because I thought It would be allot

easier than the HMO " I hate referrals " and The total Surgery cost

was over $50,000, $30,000 was for the Hospital and $20,000 for the

surgeons I was suppose to pay 10% of the total and I ended up paying

allot less than that. The total cost out of my pocket was less than

$3,000 but if you have the HMO instead of the PPO you will be 100%

covered and you will not pay nothing. I hope this helps

> Hello all,

>

> I haven't posted in awhile as I've been busy at college. I am

trying

> to endure the long and painful process of dealing with insurance

> companies. Has anyone delt with policies that do not preapprove

> surgery, but approve it AFTER you've had it? That means that if

they

> don't approve it, you're $30,000 in the hole (at least in my

case). It

> is a very high risk. By the way, I have Blue Cross Blue Shield

through

> my parents, as I am still in college. We are very worried that

the

> insurance company won't view the surgery as a medical necessity

because

> I'm not on any pain medication (although I have some pain) and it

seems

> as if I don't need it YET. Anyone have any clue how this works?

I'd

> greatly appreciate any advice.

>

>

[Guest guest]

Hi -

I also have BCBS - it's a PPO plan, and they just approved my surgery coming in

August. When I went to my consult with the OS (a year ago) he asked me about 6

questions and my answers to those as well as my records were the basis for the

insurance approval. This was actually my second insurance approval - my employer

changed from a HMO to BCBS in January after I had already gotten approval. It

seems to me that a great deal of the success of insurance approval is the talent

of the insurance specialist at the doctors' office. My surgeon had a specialist

to knew just when and how to put my package together to get approved.

BTW- I'm not on any med's - I believe the questions I was asked involved

headaches, sleeping problems, and chewing/biting issues.

good luck!

Cyndy

<alo44@h...> wrote:

> Hello all,

>

> I haven't posted in awhile as I've been busy at college. I am

trying

> to endure the long and painful process of dealing with insurance

> companies. Has anyone delt with policies that do not preapprove

> surgery, but approve it AFTER you've had it? That means that if

they

> don't approve it, you're $30,000 in the hole (at least in my

case). It

> is a very high risk. By the way, I have Blue Cross Blue Shield

through

> my parents, as I am still in college. We are very worried that

the

> insurance company won't view the surgery as a medical necessity

because

> I'm not on any pain medication (although I have some pain) and it

seems

> as if I don't need it YET. Anyone have any clue how this works?

I'd

> greatly appreciate any advice.

>

>

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