I was due to have a surgery, reconstructive surgery. After three cancellations, and many office slip ups on paperwork, my surgeons office called me the day before the surgery and stated that my insurance company denied the approval for the surgery and so they cancelled a major part of it. I later called my insurance company myself and found out the office never filed any paperwork. I went back to my surgeon's office and they could not provide me with any paperwork showing that they had submitted the promised paperwork. I am wondering what I should do about this. Any legal recourses or should I file a complaint with some agency or something? They have apologized but don't really seem to care too much.
2007-07-09 09:26:53 · 3 answers · asked by llluviaaa222 2 in Business & Finance ➔ Insurance
File a complaint with your insurance company, and file a complaint with your local Medical Society - the number is in the phone book.
2007-07-10 02:06:58 · answer #1 · answered by zippythejessi 7 · 0⤊ 0⤋
It is the participant's responsibility to precertify procedures. You have no recourse, legally.
However, do you really want a doctor who runs his/her business so sloppily actually performing surgery on you?
Find out from your insurance carrier what the normal procedure is. Usually, if you call to pre-cert, they will take the doctor's name and phone number and then call to get the necessary information. Ask that the CS rep call you when it is complete and get the pre-cert number.
Good luck.
2007-07-09 21:09:22 · answer #2 · answered by katiesquilts 4 · 0⤊ 1⤋
No one to report it to. It's a COURTESY, not a guarantee. Your best bet is to ask for preapproval forms from the insurance company, fill them out, have the doc sign them, and mail them in to the insurance company yourself.
2007-07-09 16:42:49 · answer #3 · answered by Anonymous 7 · 0⤊ 1⤋