Context: I am trying to get a breast reduction surgery that I need to prove is medically necessary covered by insurance. I have no reason to believe I won’t be approved, but I am waiting for the final call to make it official.
Hey y’all,
Today I await a phone call from an insurance rep who escalated my case to “Utilization Management” (which is another name for the Authorization Department, I learned 2 days ago). She did this because “the wrong person looked at my case” and “part of my case was not being looked at and just sitting there ‘open’” (I’m irritated that my insurance can just neglect my case like this but very thankful this rep was so helpful). I’ve been waiting for them to give me a decision for 6+ weeks.
She will have an answer for me regarding whether I’ve been approved or denied!
My question for you:
If I’m approved, what sort of questions should I ask to ensure that it’s actually going to be FINANCIALLY covered? I hear that even if you’re approved, insurance could just opt to not pay for it? Which is wild? Like, what’s the point of insurance then? Or perhaps there’s something I’m not understanding?
Here’s what I expect based on my plan: I fulfill my first deductible, insurance then pays 80% for in-network, and then once/if I hit the max out of pocket, insurance covers 100% for in-network.
I also need to make sure that not only is the surgeon considered in-network, but the hospital and anesthesiologist is in-network and approved, too.
Am I missing anything else?
I may not get a letter with written details today since I may only receive verbal confirmation of the approval or denial. I’m going to ask that they email me the letter that they intent to send to me via snail mail.
Hey y’all,
Today I await a phone call from an insurance rep who escalated my case to “Utilization Management” (which is another name for the Authorization Department, I learned 2 days ago). She did this because “the wrong person looked at my case” and “part of my case was not being looked at and just sitting there ‘open’” (I’m irritated that my insurance can just neglect my case like this but very thankful this rep was so helpful). I’ve been waiting for them to give me a decision for 6+ weeks.
She will have an answer for me regarding whether I’ve been approved or denied!
My question for you:
If I’m approved, what sort of questions should I ask to ensure that it’s actually going to be FINANCIALLY covered? I hear that even if you’re approved, insurance could just opt to not pay for it? Which is wild? Like, what’s the point of insurance then? Or perhaps there’s something I’m not understanding?
Here’s what I expect based on my plan: I fulfill my first deductible, insurance then pays 80% for in-network, and then once/if I hit the max out of pocket, insurance covers 100% for in-network.
I also need to make sure that not only is the surgeon considered in-network, but the hospital and anesthesiologist is in-network and approved, too.
Am I missing anything else?
I may not get a letter with written details today since I may only receive verbal confirmation of the approval or denial. I’m going to ask that they email me the letter that they intent to send to me via snail mail.