Insurance Question

[Skier123]

So I called my surgeons office today and asked if they have obtained written approval that my procedure is going to be covered (a pre-determination I think it is called) - and the answer I got was no ... but they have talked to the insurance company and were assured over the phone that it would be covered.

Do you guys think this is good enough? Or should I insist they obtain a written pre-determination? (I am very uncomfortable with verbal assurances from insurance companies.)

Thoughts?

Thanks.

[Gt1956]

I would advise to never accept a maybe when this much money is at stake. But on the other hand, maybe you can afford a misunderstanding. Press for documentation IMHO.

[Notgivingup]

I phoned my insurance company (Medica). I asked for a letter confirming that the procedure was covered. They sent me a letter, even though they did not formally require pre-approval. Made me feel more comfortable having that piece of paper in my hands. The insurance company didn’t seem to mind sending a letter.

[Lost Sheep]

So I called my surgeons office today and asked if they have obtained written approval that my procedure is going to be covered (a pre-determination I think it is called) - and the answer I got was no ... but they have talked to the insurance company and were assured over the phone that it would be covered.

Do you guys think this is good enough? Or should I insist they obtain a written pre-determination? (I am very uncomfortable with verbal assurances from insurance companies.)

Thoughts?

Thanks.

When there is any doubt (and especially if money or contracts are involved) get it in writing.

Also, keep a log of every phone call, every contact, with date, time name and title of everyone involved whether by direct contact or by second-hand mention. Better to have documentation and not need it than to need it and not have it.

Also, in every phone call, sign off with a cordial good-bye using the person's name. It does two things beneficial to you (this is aside from just being polite): People feel good when they are recognized and making them feel good tends to keep them on your side. It lets them know that you will remember what they told you.

[Skier123]

Thanks guys - working the issue now.

[gercoa]

Get the paper.

I didn't even know about the paper, I showed up for surgery, only to have it canceled at the last minute because the insurance said nope. Took me a month to get it approved and get the paper and now have the device in. (Day 5!)

[notaes]

i ask my surgeon the same question and he said they don't have any problems with Medicare. They should cover it all. If they don't i hope my secondary insurance will pick up balance. Mine should be covered no reason why not! But that insurance companies they do what they want.

[Gt1956]

So I called my surgeons office today and asked if they have obtained written approval that my procedure is going to be covered (a pre-determination I think it is called) - and the answer I got was no ... but they have talked to the insurance company and were assured over the phone that it would be covered.

Do you guys think this is good enough? Or should I insist they obtain a written pre-determination? (I am very uncomfortable with verbal assurances from insurance companies.)

Thoughts?

Thanks.

When there is any doubt (and especially if money or contracts are involved) get it in writing.

Also, keep a log of every phone call, every contact, with date, time name and title of everyone involved whether by direct contact or by second-hand mention. Better to have documentation and not need it than to need it and not have it.

Also, in every phone call, sign off with a cordial good-bye using the person's name. It does two things beneficial to you (this is aside from just being polite): People feel good when they are recognized and making them feel good tends to keep them on your side. It lets them know that you will remember what they told you.

To add to this. My doctors billing people clued me in to a good detail. Every contact with the insurance people is assigned some kind of number unique to the session
They advise to ask for this number. It makes it easier & faster to get back to the record of what was said. Watch out for your own best interests.

[Biker60]

I found that my insurance is self funded by my company. So Aetna handles the paper work. But employer pays the bills. Ipp does not require a pre cert for me. My employer has the implant exclusion. So right off the bat no. But can’t appeal because a pre cert is not a claim. Aetna agrees ipp are med necessary for Peyronies and Ed. However, exclusion is for anything that It is for sexual enhancement. This is vague and a need for medical exception. So I am 3 weeks out and heard nothing from the surgeon. I am having this done at a major city hospital. My primary diagnosis is PD. My employer paid 40,000 for xiaflex and all the cialis you want. Interesting I work for a healthcare system that has 5 hospitals. So, I am going to go with it. I assume they will get some verification. If I have to pay, I will negotiate the Medicare rate. Which is 13k for the implant and $900 each for Dr and Anesthesia. I will be 59 next week. Too early for Medicare. You know even with a positive pre-dermination they can still deny the claim. So I will just appeal and or eventually negotiate something.

[Biker60]

https://www.bostonscientific.com/conten ... _FINAL.pdf

This is the max amount that be charged via Medicare in different settings. The hospital obtains the implant and marks it up accordingly.