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Is it difficult to get my Insurance to authorize a surgery after the fact?
Mar
24
2010
Long story short, I had surgery on my foot and the insurance company did not pay my doctor since the surgery wasn’t “authorized”. Is there a way to get an insurance company to authorize the surgery after it already took place?
Answer #2
Michelle is correct. If you were using an in-network provider they cannot bill you as they are responsible to get prior authorizations.
If your foot surgery was provided by an out of network doctor then the answer depends on your coverage and your policy rules. For starters you must have out-of-network coverage. If you have an HMO policy they will not pay.
If you have out of network coverage, by having a POS, PPO, or indemnity policy, than you have a chance.
Call your insurance company and find out what type of coverage you have. Once you verified that you have out of network coverage then you can ask what you need to supply to have your foot surgery considered for payment.
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Answer #1
If the doctor who did the surgery was an In-network provider for your insurance company, then it was THEIR responsibility to get the authorization. If they did not, and now insurance is not paying….they can NOT bill you for it.
If the doctor was not an in-network provider, the story changes, then it was your responsibility to let your insurance company know ahead of time. You can always appeal their decision if this is the case. Contact me if you need, help. I would be happy to assist you.
Michelle Jorgensen, Owner
Medical Claims Consulting
Ph: 512-439-9679 Fax: 888.736.9656
Website: http://www.medicalclaimsconsultant.com
A voice that speaks for you in the health insurance system