No Pre Authorization or Determination by Insurance Company

I have a plastic surgeon and chiropractor state I need a medically necessary breast reduction. After 12 weeks the insurance company stated, though I went through all appropriate avenues they no longer do pre authorizations for this procedure. So the surgeon office asked if they would do a pre determination, and again we’re told no.

So I am left with paying out of pocket or signing something that states they will bill my insurance and if they deny I am on the hook for the full amount (which is more than paying out of pocket).

I just wonder if anyone can help me navigate this. Can the insurance company tell me the price they would be billed before (doctors office stated they don’t have this because it’s proprietary information)? Should I be asking certain questions to my insurance company to be able to determine if it would be paid?

I have called my FLMA admin who stated they don’t care who pays for the procedure, if the doctor signs off on FLMA I am covered for my job, which is nice.

Any help or insight is appreciated.

submitted by /u/CrankyBoxOfWine
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