Awaiting Pre-Authorization for a Hip Surgery

Hello. Tomorrow, I’m scheduled to have open hip surgery to fix an FAI impingement and repair my labrum.

This surgery has been planned for ~6 months now. Unfortunately, the surgical scheduler informed me on Saturday that they had just NOW initiated pre authorization for the operation. Per her, they had previously gotten generic “no authorization required” statements from CIGNA (Open access plus), so there wasn’t a need to perform one.

The hospital facility discovered that one of the six CPT codes actually DOES require pre-authorization (27299). Thank god they found out less than 24 business hours before the operation (on a holiday weekend 😃). They provided an outrageous quote (should the insurance refuse to pay for it). They assured me it’s very unlikely for it to be that high. ($21k “inflated estimated” as opposed to $2900 with my insurance’s EOB).

This surgeon is very reputable; the registration staff noted he would’ve postponed the 5-hour OR slot if he didn’t think this surgery was medically justified.

Does anyone have an experience similar to this? I’ve exhausted all conservative options (PT, steroid injections in 2022, and activity modification). The CT scans, MRI’s and XRays couldn’t be more indicative of an impingement.

Should I be worried about going through with this? I doubt we will hear back from authorization before 11AM tomorrow. I mean, I am in incredible pain everyday of my life.

Cheers

submitted by /u/BushDoctorPhD
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