Earlier, I mentioned that insurance companies place the burden upon the insured to verify Pre-Authorization of certain services and procedure. Some physicians are beginning to do so, as well—placing language to that effect in their intake papers. I also mentioned that doctors’ offices sometimes make inadvertent mistakes. Well, this is what happened to me a few months ago…..
My shoulder hurt terribly. What ended being an impingement (fortunately nothing structural), almost cost me many thousands of dollars—a pain in both the shoulder and the pocketbook.
My doctor ordered two MRIs—one of the chest and one of the shoulder. One of his staff initiated the process of scheduling the MRIs for 4:30 PM on a Friday at a nearby hospital. I called the hospital at 2 PM to verify—and was told that authorization had not been received. After two calls to the doctor’s office (they were “working on it”), I received a call back at 4:15 PM. The doctor’s assistant told me that I’d been approved. I asked for the authorization number. The hospital representative told me that it was a “tracer number”:–meaning that a file had been opened. It was NOT an authorization for the procedures.
I was in quite a bit of pain-so Monday was going to be the day for the procedures, The hospital rep called me promptly at 10 AM to advise that I’d been approved and gave me the authorization number. The hospital was ready to go.
I decided to verify with the insurer (Florida Blue), which uses an outside company to process pre-authorizations. Asked whether they place two procedures on one number-the reply was no-one number for each procedure. My shoulder MRI had been approved-they had no info about an MRI of the chest.
I went to the doctor’s office and asked the office manager if there was a private place she and I could speak with the employee who had processed the preauthorization. Apparently, that person neglected to read the prescription fully-she overlooked the order for an MRI of the chest; applying only for the one for the shoulder. I asked that they (officer manager and employee) call processing company and put the nurse on the phone to relay the clinical information necessary to process the request. 15 minutes later I had the approval.
It was an innocent (albeit sloppy) mistake by the office person. But, my insurer’s plan specifically states that obtaining such a procedure without pre-authorization would make me 100% responsible for the $4800 charge. The papers I signed when I became a patient at the Doctor’s office said that I was responsible for obtaining my own reauthorizations. Had I not verified—I would have been out $4,800.
So VERIFY (with your insurer) that the pre-authorization has been obtained and write down the reference number. Then check that against the number of the facility (hospital or free-standing) performing the procedure. Then you’ll be good to go. Until next time, Human Health Advocates wishes you the best of health!