Provider failed to get prior authorization
So I’m supposed to have surgery on Tuesday. Today I received the billing code the provider is going to use. So I call my insurance company just to get an idea of what it’s going to cost me. They tell me prior authorization is required and my provider hasn’t submitted a request. How does a provider fail to get prior authorization?? Their billing department knew what code they were going to bill. They called my insurance company to get my insurance details. But they never submitted a request. And it wasn’t something I could check before today as I didn’t have the code or even the proper name of the procedure (just a description of what it was). My insurance basically told me they’d deny the claim and a prior authorization takes 48-72 to process which cuts down to basically day of surgery assuming they submit the request as soon as they open tomorrow. So I’m left with canceling a needed surgery because my provider failed to do their job.
submitted by /u/Kalypsokel
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