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Fresia
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Member Since Apr 2010
Location: Off yonder
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PC PoohBah!
Default Jun 16, 2010 at 08:43 AM
 
I have worked for several hospitals in billing and insurance verification. Just for future reference, when calling to pre-authorize/certify a procedure, one of the things is not to discuss your symptoms only the procedure needed, doc and date of service and to verify your coverage. Otherwise it can bias the coding when it comes in. Also, you have grounds for an appeal if you documented the date, time and person you spoke with who said it would be covered. Doesn't mean it will go through but it is worth pursuing.

Contact the doctor office first to get help redirecting the billing to routine. It may not be possible unfortunately but they can be they can be your advocate. However, they may still consider it medically necessary unfortunately.

Good luck.
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