Insurance Question

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TickledPinkTwice
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Date Joined Mar 2011
Total Posts : 242
   Posted 5/19/2011 6:34 PM (GMT -6)   
So I called my Insurance (Anthem BCBS) to ask if my surgeon was covered. She said NO and named off some other surgeons. Well, she named off every other doctor in the practice. So I called the office and the lady said that yes he is covered because they are all under the same tax id number. Well I talked to another BCBS representative and I told her what the nurse said and she said yes than he is in-network. So which is it? Any experience with something likes this?
Mary 26,Chronic Constipation
Colonoscopy: Polyps,Melanosis and long redundant colon, Sitz Marker: Colonic Inertia. Defecography:Rectocele and Enterocele, Anorectal Manometry:Normal, Pudendal Nerve Study:Normal, Gastric Emptying-20% at 4 hours, Small Bowel Followthrough:Reached the Cecum at 30 MINUTES!!
5/26-Surgeon Appt

Disneynut66
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Date Joined Apr 2009
Total Posts : 587
   Posted 5/19/2011 7:42 PM (GMT -6)   
I would assume they would have to do a pre-approval and it would have the surgeon's info so you could see.
Diagnosed 2006. 1st step of 2 step j-pouch 1/3/11. 2nd step April 4, 2011. So done with this disease.

Another UC wife
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Date Joined Jun 2007
Total Posts : 2111
   Posted 5/19/2011 9:57 PM (GMT -6)   
Disneynut66 said...
I would assume they would have to do a pre-approval and it would have the surgeon's info so you could see.
 
Ditto - I agree.     If you want.... For peace of mind (I did this with the Mayo Clinic pre approval area) speak with the proper person in the surgeon's office/practice and get the pre-approval information.  I knew the Mayo Clinic and the doctors there were ok with our insurance for my husband, but I wanted to be sure the actual operation to be performed was ok'd before the fact.  Just didn't want to leave anything to chance and have any issues after the fact.

TickledPinkTwice
Regular Member


Date Joined Mar 2011
Total Posts : 242
   Posted 5/20/2011 5:41 AM (GMT -6)   
How do I go about getting a pre-approval?
Mary 26,Chronic Constipation
Colonoscopy: Polyps,Melanosis and long redundant colon, Sitz Marker: Colonic Inertia. Defecography:Rectocele and Enterocele, Anorectal Manometry:Normal, Pudendal Nerve Study:Normal, Gastric Emptying-20% at 4 hours, Small Bowel Followthrough:Reached the Cecum at 30 MINUTES!!
5/26-Surgeon Appt

Another UC wife
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Date Joined Jun 2007
Total Posts : 2111
   Posted 5/20/2011 6:20 AM (GMT -6)   
When we met with the colo rectal surgeon and were sent our patient itinerary with the pre op info and surgery date I called the billing department at Mayo...asked a few questions and told the gal my concern and was transferred to another gal that does the pre approving.

Truthfully I had called too early and she had not gotten around to my husband's file yet. I asked when could I call her back to just make sure everything was ok. She took my tel # and called me back several days later and gave me the blue cross approval code or case # whatever it was called.

His original scheduled surgery was for a 2 step procedure hoping that the j-pouch was going to be performed with the takedown 3-4 months later. As it turned out his surgery was 7 1/2 hrs long, quite complicated and he ended up with a permanent ileostomy. He was in the hospital for 8 days.


Before discharge it was determined he needed home health care nursing services to help manage the ileostomy to be sure he was self sufficient. When the person at the hospital came in to get info and give us the info I ALSO MADE SURE I got from her the blue cross approval code. When we got home I called and verified with blue cross the terms of the approval. In my husband's case it was for a maximum of 12 visits between a certain time period. As it turned out we used 11 of the 12 visits as the last visit occurred on the last day of the approval process as I logged each visit to be sure we fell in the proper parameters as these visits are expensive. By that time we were fine anyway but it was reassuring to have the nurse to not only make sure we knew what we were doing but his overall health and vitals and wound checking was being monitored too.

Hope this helps.
64 yr old male suffered with UC & in May 06 had a severe flare & hospitalized 6 days...various prednisone treatments leading to steroid dependence and osteopenia, 12 asacol, 200 mg Imuran, failed remicade infusions Jan-May 2010 Dependence on pain meds. Made decision 6/10 to have surgery which was on 12/17/10 (total proctocolectomy & ileostomy - unable to have the j-pouch) and no longer in pain.

suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5698
   Posted 5/20/2011 7:01 AM (GMT -6)   
Pre approvals are usually handled by the surgeon's office.

Sue

Another UC wife
Veteran Member


Date Joined Jun 2007
Total Posts : 2111
   Posted 5/20/2011 7:26 AM (GMT -6)   
In our case Sue maybe because it was the Mayo Clinic they handled my husband's this way?????
64 yr old male suffered with UC & in May 06 had a severe flare & hospitalized 6 days...various prednisone treatments leading to steroid dependence and osteopenia, 12 asacol, 200 mg Imuran, failed remicade infusions Jan-May 2010 Dependence on pain meds. Made decision 6/10 to have surgery which was on 12/17/10 (total proctocolectomy & ileostomy - unable to have the j-pouch) and no longer in pain.

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 5/20/2011 5:15 PM (GMT -6)   
In my experience, it was my surgeon's office. Once my surgery was booked I'd see the 'financial' person who'd make sure they had my correct insurance info and take it from there. I never had to contact my insurance to make sure, but I guess I could have if to make sure.

Do you have a website for your insurance? You can probably look it up that way, too.
formally known as OHIO76 ~ honoring my daughter's passion!
Crohn’s dx 1989
some terrible years before my temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

TickledPinkTwice
Regular Member


Date Joined Mar 2011
Total Posts : 242
   Posted 5/20/2011 5:27 PM (GMT -6)   
Thanks so much.
I do have a website but it won't let me set up an account because it says my number is wrong, stupid Anthem.
Mary 26,Chronic Constipation
Colonoscopy: Polyps,Melanosis and long redundant colon, Sitz Marker: Colonic Inertia. Defecography:Rectocele and Enterocele, Anorectal Manometry:Normal, Pudendal Nerve Study:Normal, Gastric Emptying-20% at 4 hours, Small Bowel Followthrough:Reached the Cecum at 30 MINUTES!!
5/26-Surgeon Appt

polishdan
Veteran Member


Date Joined Mar 2010
Total Posts : 1595
   Posted 5/20/2011 6:27 PM (GMT -6)   
Stupid insurance companies.........I had my surgery November 7, 2007. When the surgeons office called for the pre approval in November they were told my coverage had lapsed. Turns out payments are not posted until the 10th of each month. I never had coverage early in the month. Dr office always had to call to verify coverage before the 10th.

Dan

TickledPinkTwice
Regular Member


Date Joined Mar 2011
Total Posts : 242
   Posted 5/20/2011 6:34 PM (GMT -6)   
Oh I know what you mean. Everytime I go to register at the hospital they say I am inactive until they go to the Anthem website and see that I am in fact covered!
Mary 26,Chronic Constipation
Colonoscopy: Polyps,Melanosis and long redundant colon, Sitz Marker: Colonic Inertia. Defecography:Rectocele and Enterocele, Anorectal Manometry:Normal, Pudendal Nerve Study:Normal, Gastric Emptying-20% at 4 hours, Small Bowel Followthrough:Reached the Cecum at 30 MINUTES!!
5/26-Surgeon Appt

TickledPinkTwice
Regular Member


Date Joined Mar 2011
Total Posts : 242
   Posted 5/24/2011 7:17 AM (GMT -6)   
That is great,that is how it should be!
Mary 26,Chronic Constipation
Colonoscopy: Polyps,Melanosis and long redundant colon, Sitz Marker: Colonic Inertia. Defecography:Rectocele and Enterocele, Anorectal Manometry:Normal, Pudendal Nerve Study:Normal, Gastric Emptying-20% at 4 hours, Small Bowel Followthrough:Reached the Cecum at 30 MINUTES!!
5/26-Surgeon Appt
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