Update: Anthem won’t give pre authorization because pre authorization is not required

Hello, I am not sure how to put an update on my previous post. I messaged the mods for help but I didn’t get a response. Please let me know if this post needs to be formatted in a different way to meet the subs’ guidelines.

Here is the update. Anthem is not giving pre-authorization because pre-authorization is not required for the specific wheelchair mechanism. They have given pre-certification but that is not a guarantee that they will follow through and pay for any portion of it. I also have secondary Medicaid through the end of July (which I can’t remember if I specified in my previous post).

Many of you told me in the comments of my last post that the DME supplier (since they are contracted with Anthem and Medicaid) is in charge of getting pre-authorization and if they don’t get pre-authorization then they are on the hook if to pay if Anthem denies the claim.

However, they are wanting me to sign a paper saying that they are not responsible for payment if Athem (or any other insurance) denies the claim. To me that sounds like they are trying to get me to sign so that they aren’t liable to refund me/pay for the part if Anthem doesn’t pay. What if Medicaid doesn’t pay? They are contracted with Medicaid so aren’t they legally required to pay?

Obviously I don’t want to sign the paperwork because that sounds shady. They are trying to get out of payment when they are contracted to pay if my insurance does not. Is this place being shady? I have been working on this for a year already but I’m wondering if I just need to start over because I can’t risk no insurance paying and being out 9k. What should I do?

Any advice is appreciated. Thank you & thanks again to everyone who gave advice on my other post. I will link that post in the comments.

submitted by /u/throw_awayy_reddit
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