Do I have my ducks in a row for this procedure and the insurer?

I’m getting an outpatient procedure done this week (unless an issue comes up, then I’ll reschedule). I have BCBS PPO employer backed.

I’m checking if my doctor marked it as medically necessary on record and with insurance. I’m checking the insurance side also to see if there is “medically necessary” a requirement for the procedure code or limit, or exclusion.

I confirmed my plan states for pre-approval that “preauthorization may be required”. I then called the insurer and had them confirm whether I needed pre-auth for the CPT codes in an outpatient situation. They sent me on paper that the codes didn’t need pre-auth. The hospital confirmed they checked with my insurer that the codes didn’t need pre-auth. I will check once more that the pre-auth applies to an outpatient setting, not just the codes.

I confirmed the doctor and hospital is in network. I confirmed all the CPT procedure codes I was given on the hospitals estimate. I will call the hospital when they can tell me the anesthesiologist on staff and confirm them also or reschedule if they’re out of network.

The hospital says they “usually” don’t use third party staffers but I’m checking anyway day of.

I don’t know if labs or pathology I should check.

I know my out of pocket and deductible and how these costs should work out if everything is in network and nothing is denied.

I do not want to see this claim denied or a bigger bill than I am prepared to pay outside of my plan’s outlines.

Am I missing anything?

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