Can you guide me to find any sort of legal back up PPO's have to obtain preauth or I'm not liable
I had a procedure done that my Doctor did not preauthorize and my INS co says "Not medically necessary" I was hoping you could guide me to any law that would back up the statements you made about me not being financially responsible if they don't get the authorization. The doctor is in my network of preferred providers.
Please go to my profile page and choose contact me- want some more info- was this emergency room, surgery? Whoever provided the treatment, if they are a member of the PPO, in their contract with the insurance company, they have a clause that says they will get auth or they will not bill you. I have, in the past, asked to see a copy of the md's contract, found the clause and pointed it out to them- but need to know what kind of service...If you were an inpatient at your member hospital, they MUST get auth- they know this- Please check to see if your state has a dept of managed care. If not, you need to file all of the info regarding what happened with the Insurance Commissioner. If there is a Dept of Managed Care, file with them. Then you need to tell the provider who is billing you that you have filed a complaint.
Also, your doctor can ask the ins co for a retroactive auth. They need to submit the records to show that it was medically necessary and help you appeal the ins co decision.
Was it a medically necessary thing? For example, most plastic surgery is not medically necessary, so that would be an exception.
Sorry- I don't have enough info to give you really specific advice, but would love to be able to help you.
Hub Pages will send me an email with any info you provide and I will email you back. This will be confidential...
Jillian, I'm sorry I can't seem to find a place to message you. email me at email@example.com
by Emily Zeinert 3 years ago
Are you for or against legal euthanasia (medically assisted suicide)?What are your thoughts? Why do you or don't you agree?
by mdawson17 9 years ago
Many times it is medically necessary to have an abortion when do you think it is medically necessary?
by Jacqui 5 years ago
Is procreation necessary for a marriage to be valid/legal?Well, is it? Many of the opponents to same sex marriage state the obvious in saying - 'you cannot procreate' - as the basis of the reason that they feel SS marriage shouldn't be legal. Yet plenty of heterosexual marriages are formed by...
Copyright © 2018 HubPages Inc. and respective owners. Other product and company names shown may be trademarks of their respective owners. HubPages® is a registered Service Mark of HubPages, Inc. HubPages and Hubbers (authors) may earn revenue on this page based on affiliate relationships and advertisements with partners including Amazon, Google, and others.
|HubPages Device ID||This is used to identify particular browsers or devices when the access the service, and is used for security reasons.|
|Login||This is necessary to sign in to the HubPages Service.|
|HubPages Traffic Pixel||This is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.|
|Remarketing Pixels||We may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.|
|Conversion Tracking Pixels||We may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.|