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ADR in one week...still battling insurance

AnonymousUserAAnonymousUser Posts: 49,082
edited 06/11/2012 - 8:36 AM in Health Insurance Issues
I am new to this forum and hoping someone can help shed some light on how to handle an insurance issue. I am scheduled for surgery on 9/21. My surgery coordinator contacted the insurance company over 1 month ago to obtain prior authorization for a single level ADR. At that time the she was told that no prior authorization was necessary for this procedure. The surgery coordinator found this to be quite unusual so she called again last week to double check and was reassured that prior authorization was not needed. The neurosurgeons office was then satisfied with this response and left it at that, however when this information was relayed to me I felt that this needed more investigation. I contacted the pr. auth. dept. and was given the same info, that it was not necessary. I then asked if this in fact meant that the surgery would be covered and was told not necessarily...it depends on my benefits (this was never discussed with surgeons office). I was then transferred to benefits where after speaking with several people and getting nowhere, was sent to a supervisor who indicated that this was a covered benefit as long a prior authorization was obtained. When I indicated that according to their own prior authorization department this was not needed, the supervisor said that all I could do was notate who I spoke with in prior authorization and this would be my proof should payment become an issue.

I am sorry for rambling...but here are my questions.

Has anyone ever heard of ADR surgery not needing prior authorization?

Being that my surgery is in just over 1 week and this will probably not get resolved that quickly, do you think it is safe to move forward with the surgery and rely on the statements of the supervisor?

Any help would be greatly appreciated.




  • whether they will pay or not. As with mine no authorization is needed for a lot of things like mri's and such but when it comes to surgery or a CT scan which are more expensive they do require authorization. I guess it would depend on who your carrier is. You may actually be charged for all or part I would definately get the name of the person telling me i didnt need authorization that way you have some sort of back up. As of right now my family has pretty good insurance and i can choose any doctor without referrals and this is great but like i said when it comes to something big they require authorization. Yours may be right and you dont need it but then again you never know. Good luck and sorry i can not help but i sure hope you get it all worked out.
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