Topic: Get your Approval Codes?

I went for a Pet scan back on Feb 21.  First it was denied, after a few calls, it was then approved, they had it all figured out how much I had to pay up front, which included my 2009 deductible of 500.00. 

Fast forward, I had another scan in April, this time a ct scan.  I get the insurance info as to how much they are paying on the Radiologist Fee, and get this, they are paying nothing, as it shows, I have not paid my deductible for 2009. 

Just got off the phone with BCBS, they denied payment for the PET scan, as they did not submit the correct code, and had requested my medical records from the referring Dr as to why I needed the scan.  Well, What about the prior authorization?  It was approved?  Oh, I am so frustrated!!  She was telling me on the phone, that I need to contact the Dr. and have him send this information, then after digging deeper, found they already had it on file, and had not processed any of it.

So, now, depending, on whether the records they have requested, contains the correct code or not, I am now on the hook for the full amount of this other bill, and, the PET scan company, well, they apparently will owe us a refund, for that 500.00, IF, the dang insurance pays them.

This Country has got to do SOMETHING, with the way Health Care is being handled. 

My point of the rant, I guess, talk to the insurance company yourselves when getting prior approval, and get any codes you can  so when the Medical coders and billing companies file, they get timely payment.    Not that I have a clue as to how any of this works.  I figure we pay for the insurance, why should we have to track billing codes???

Re: Get your Approval Codes?

You are so right.  Dealing with the insurances companies adds another layer of frustration.  I am just wondering, though.  Has the physician's office filled out the coding required?  In our case, we had them battle it out on our behalf.  I withheld payments to anyone until the matter was resolved.  Thanks for sharing.

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Get your Approval Codes?

Marion,

Thanks for responding.   The lady I spoke with did not go into whether or not the info had the required coding, only mentioned that the info was there and had yet to be processed. 

As most people right now, we just don't have another 500.00 to lay out for the deductible.  My husband has gone from working 50 hours a week , down to 32, due to lack of work .    We are just going to wait for all the paperwork to be processed, and see who gets what.

Re: Get your Approval Codes?

Jill,

I feel your frustration. I think BCBS has a standard procedure to deny payment,  regardless of pre-authorization. I do think they will eventually pay it. For my Dad, the same thing happened, pre-auth in hand, we had the procedure and they denied one because of medical justification and the other for the need for medical notes.

I think they try to tie you up with red tape so you won't seek expensive treatment because of the threat of having to pay out of pocket.

One of my dad's doctor's offices told me that it was common, but she also said they may threaten to deny it, but they can't.

Unconscionable, if you ask me.

Re: Get your Approval Codes?

Just to update here, We received our overpayment refund from the PET Scan company in the Mail on Saturday.  Finally!