I am wondering

helensmith · 09-28-2006, 06:06 AM

Hi question? does having your aptointments fro doc and pre op seminar and the nutri, mean they have already been acepted for payment from my insurance? it said it would cover it , im just wondering if they have already, figured the doc would not make apt if not what do you think?

***Susan*** · 09-28-2006, 07:10 AM

I would not proceed with anything until you have asked your doctor's staff if they have received approval for the surgery from the insurance company. Either that, or contact your insurance company directly. Unless you are prepared to self-pay, it is better safe than sorry.

**Alexandra** · 09-28-2006, 07:43 AM

Hi Helen,

It's not true that scheduling appointments means your doctor is confident of payment by your carrier. Not at all. You should investigate on your own whether your care will be covered, and if there are problems with payment down the line you will have to explain why you believe the claims should be paid. Are your providers in-network? Is the condition being treated a covered condition (i.e., morbid obesity)? Do you need referrals from a PCP and if so, do you have them in place before seeing your specialists?

No carrier or doctor's office will ever promise you that a claim will be paid beforehand; insurers will always say they have to see the actual claim before a determination can be made. But you can certainly get a sense of your rights and responsibilities beforehand, and if you're acting in accordance with the terms of your contract you should have a reasonable expectation of payment.