Medicare Pre-Authorization Question

cinnamonsmile
cinnamonsmile Member Posts: 1,187 Member
in Breast Cancer #1

I am having a rather expensive procedure in two weeks. I called Medicare to see if they pre-authorized it. They could not give me any information about it. All the Medicare representative said was that I would have to call the clinic.

Well, I already have problems with the billing department. They mailed me a bill for services a full year later. I called to find out why. They said that there was a problem with the first time they sent it to insurance and that they resubmitted it several more times and that it kept being denied. I called the insurance company and they said the first time was rejected because there were NO billing codes on it. They claim they never received another claim submission. I called the billing department and they refused to put me in touch with the billing reps that could give me the dates of submission so I could compare with insurance. They never called me back. Obviously I have not trust for them.

I called the pre-authorization representative at the clinic and she refused to say if it was authorized. She said she has "heard" that Medicare pays for the service I am receving.

Can the clinic get pre-authorization from Medicare for procedures?? 

Hopefully someone knows and can give me somewhere on the internent so I have proof. I could really use some help with this.

Thank you.

Comments

  • coco2008
    coco2008 Member Posts: 418
    #2
    The doctor or hospital should

    The doctor or hospital should be able to make sure if the cost is coveredor not by your insurance.  My onco confirms coverage before running a test or procedure.  They want to make sure they get paid and that I don't get hit with a big bill I didn't know was not covered.

    If the people you are speaking to cannot do this, get the name of a superior or head of the hospital and contact them.

  • Candi Cane
    Candi Cane Member Posts: 159
    #3
    I don't anything about

    I don't anything about medicare, but, the clinic should be able to get approval from them.  If you get nowhere still, ask for a supervisor or whomever is in charge.  My cancer clinic even called before I started radiation and got the approval for them.

    Good luck

  • cinnamonsmile
    cinnamonsmile Member Posts: 1,187 Member
    #4
    Candi Cane said:

    I don't anything about

    I don't anything about medicare, but, the clinic should be able to get approval from them.  If you get nowhere still, ask for a supervisor or whomever is in charge.  My cancer clinic even called before I started radiation and got the approval for them.

    Good luck

    Bumping up hoping someone who

    Bumping up hoping someone who has Medicare can bring some insight,too.

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