pre-existing condition and what insurance to get

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#16 Post by **Rodney008** » Sat Oct 02, 2010 9:45 pm

schwin wrote:Wow Rodney thats good news. I'm BCBS Basic also, did you have any in-network Orthongathic surgeons or did you have to get an exception?

He is in our network and so is the hospital.

#17 Post by **Sandra1229** » Wed Oct 06, 2010 2:12 pm

Rodney,

Fake date? How far away was the date? My daughter needs surgery but we are looking at a year from now. I have BCBS too.

Wed Oct 06, 2010 4:26 pm

Sandra- BCBS gives approvals that expire one year. They just filled in the day it was submitted for approval for surgery and the pre-auth expires one year from that date.

#19 Post by **Sandra1229** » Wed Oct 06, 2010 7:13 pm

mamaneedsanewjaw,

Thank you for the info. We r going to another surgeon that is in the network the 19th. Hopefully he can get the approval.
Do you happen to know if it is over a year,..will they extend it?

#20 Post by **schwin** » Thu Oct 07, 2010 4:21 am

mamaneedsanewjaw wrote:Sandra- BCBS gives approvals that expire one year. They just filled in the day it was submitted for approval for surgery and the pre-auth expires one year from that date.

BCBS only gave me six months from June 2010 so I just got surgery approved and scheduled for Nov. 29 =T

Thu Oct 07, 2010 6:46 am

Sandra- I think if you go past a year the surgeon's office will have to file for an extension. My ortho thought I would need to be in braces for a year prior to surgery and he was aware of the time frame with the insurance and he pushed it with me (more frequent appointments) to be sure I was ready before my year approval ran out. I was actually ready for surgery after five months in braces. My teeth were pretty straight to begin with so it was more of getting the bite in order.

BCBS is such a large company and so many different plans under it that it is hard to know the time frame your individual plan will have.

I know it is frustrating and so very confusing but that is insurance for you!

#22 Post by **Rodney008** » Thu Oct 07, 2010 7:30 pm

Sandra1229 wrote:Rodney,

Fake date? How far away was the date? My daughter needs surgery but we are looking at a year from now. I have BCBS too.

Yeah, when I first saw my doctor my insurance would not give a straight answer on the coverage. So he sent them a precertification with a fake date a month out. They sent a letter back stating my procedure was medically necessary and is coverered.

#23 Post by **schwin** » Sat Oct 09, 2010 9:08 pm

anyone have to make a deposit even with pre-certification? They want 1600 from me up front... sigh after 5500 in braces..

#24 Post by **beowulf68** » Tue Oct 19, 2010 6:30 am

schwin wrote:anyone have to make a deposit even with pre-certification? They want 1600 from me up front... sigh after 5500 in braces..

Besides having to have Surgery for my Jaw, I have Crohn's Disease too and over the years have had multiple surgeries because of Crohn's and never once did I have to pay anything up front. Depending on the insurance I had at the time, I might have had to pay a co-pay or deductible, but I was billed for that after the fact.....Never up front.

If I had a co-pay or deductible, my corporate benefits dept. told me NEVER to pay anything up front. Always wait to get a bill because you never know how much was going to get paid out by the insurance company. This probably had to do with the negotiated rates between the hospital and the insurance company which could change at any time.

#25 Post by **BaliGirl** » Tue Oct 19, 2010 5:52 pm

I consulted with 2 out of network surgeons in my area. Both required FULL payment of the estimated surgery amount ($20k+) by the day of surgery even if I receive pre-certification from the insurance company. Apparently the insurance companies are famous for slow pay, no pay, changing their mind, etc. and pre-certification doesn't mean much. Very frustrating.

I would think that in-network providers would not charge a deposit up front, but I don't know for sure. There are only 2 in-network surgeons in my area and they have a 9 month waiting list for a simple consultation, so I didn't even consider them.

#26 Post by **schwin** » Thu Oct 21, 2010 5:28 pm

I got approval for my surgery on Nov 29 2010 but insurance won't tell me how much they will pay. this sucks. I am due deposit for 1500 next month but i'm not sure what to expect after that ....

#27 Post by **24braceface** » Sat Oct 30, 2010 1:30 pm

How long does it take insurance to pre-approve? Is it years, months, days, what?

#28 Post by **WiredRunner** » Sat Oct 30, 2010 1:40 pm

For me, it took about two months to get my pre-approval. I have Aetna POS II.

#29 Post by **24braceface** » Sat Oct 30, 2010 1:49 pm

WiredRunner wrote:For me, it took about two months to get my pre-approval. I have Aetna POS II.

I just got a new insurance, and obviously this is a pre-existing condition, should I start trying to get pre-approved now?

#30 Post by **Christina28** » Sat Oct 30, 2010 3:31 pm

Pre-payment for surgery, even with insurance approval, is pretty common with doctors in private practice. An option for covering this until insurance payment can be Care Credit or other types of financing which can give you up to a year at 0% interest. Your OS has to participate and you do have to come up with monthly payments but it is better than paying the whole thing at once!