1. Good for you for getting the cats spayed/neutered. No more accidental kittens.
2. I work for an insurance company, in the authorizations department (not in Florida, somewhere else). Here is some helpful advice in getting your surgery covered.
Once you know who your insurance is:
1. Choose a Dr./Surgeon who is in your insurances provider network. If you don't know who those are, call the Customer Service department at the insurance and they will help you. This will ensure the best coverage. Make sure the hospital is in-network too.
2. Ask the Dr./Surgeon what procedure codes they will be billing. Call the insurance company and ask them if those codes are covered.
3. If the insurance says that authorization is needed, submit the following: -A letter from you detailing how your abdominal issues affect your daily life (can't pick up the kids, can't stand for a long time, etc…) Don't include emotional issues (people assume you're pregnant, etc…) just stick to the facts. Keep is simple, don't write a novel, but be truthful. - Any and all chart notes/office notes from any doctor visit you have had about this issue or where you talked about this issue, back to when it first began. ER visit notes, office visit notes, everything. You have a right to have copies of all your medical records, for free. Also ask any doctors you have seen if they will write a letter stating why they feel the surgery is necessary. - Photos if you have them (below the neck).
4. The hernia repair should be coverable. It’s the stomach reconstruction that might be an issue. But if you can prove that it causes you to not be able to function during your daily life, and that it is a growing medical concern (i.e., it’s only going to get worse, it has not stabilized), you may be able to get it covered by insurance.
5. Give the insurance company at least a few weeks to make a decision (ask how long their preauthorization process is). Also know what the appeal process is (there always is one). If it’s denied, don’t be afraid to appeal.
(my advise is no guarantee, I just know what kind of factual information is helpful. )
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Date: 2011-03-31 07:26 am (UTC)2. I work for an insurance company, in the authorizations department (not in Florida, somewhere else). Here is some helpful advice in getting your surgery covered.
Once you know who your insurance is:
1. Choose a Dr./Surgeon who is in your insurances provider network. If you don't know who those are, call the Customer Service department at the insurance and they will help you. This will ensure the best coverage. Make sure the hospital is in-network too.
2. Ask the Dr./Surgeon what procedure codes they will be billing. Call the insurance company and ask them if those codes are covered.
3. If the insurance says that authorization is needed, submit the following:
-A letter from you detailing how your abdominal issues affect your daily life (can't pick up the kids, can't stand for a long time, etc…) Don't include emotional issues (people assume you're pregnant, etc…) just stick to the facts. Keep is simple, don't write a novel, but be truthful.
- Any and all chart notes/office notes from any doctor visit you have had about this issue or where you talked about this issue, back to when it first began. ER visit notes, office visit notes, everything. You have a right to have copies of all your medical records, for free. Also ask any doctors you have seen if they will write a letter stating why they feel the surgery is necessary.
- Photos if you have them (below the neck).
4. The hernia repair should be coverable. It’s the stomach reconstruction that might be an issue. But if you can prove that it causes you to not be able to function during your daily life, and that it is a growing medical concern (i.e., it’s only going to get worse, it has not stabilized), you may be able to get it covered by insurance.
5. Give the insurance company at least a few weeks to make a decision (ask how long their preauthorization process is). Also know what the appeal process is (there always is one). If it’s denied, don’t be afraid to appeal.
(my advise is no guarantee, I just know what kind of factual information is helpful. )