Pre-Screening Tests a Dilemma

Marlluvia · June 7, 2006

OK, here goes. My doctor wants me to have some pre-screening done for the surgery, however, I am not yet approved by my insurance. That means if insurance denies my claim, I am stuck with a big bill. I don't have the means to pay for medical bills right now, that's why I'm trying to get approval thru ins. When I spoke with the nurse at my first consult she said it would be good to have these ready once I was granted approval. To me, that meant, it would be good for me to have them done, but don't necessarily have to for paperwork submittal. I called doctor's office this morning and asked if prescreening was part of paperwork submittal to ins. They told me it would be helpful. When I told her about not being approved yet and having to pay for all the expenses myself, she put me on hold. She came back and told me that they would submit my paperwork without them, and would probably know something in about 3 days. After all this rambling, my question is: Did everyone here have to submit their pre-testing with paperwork to get approval? Please enlighten me for I am confused and somewhat frustrated.

Gracie

Marimaru · June 7, 2006

Gracie,

I did not go through insurance, so most of what I know is based on what I've read here and at other forums, but I think the part of the pre-screening that helps with the insurance is if they discover any co-morbidities that maybe you didn't know about. Lots of people found out they had Sleap Apnea, or pre-diabetes because of the pre-screening for surgery. That may be what she thought was helpful.

Hopefully more people will chime in that actually have experience with this. Good luck, and try not to stress yourself out!

medussa · June 9, 2006

Here goes....

I have PPO BCBS insurance but did not use it. (did not want to wait another year) I had all the pre screeening done and submitted to my insurance comp. They paid.

My prescreening included: Labs, EKG, Pulmonary Function test, CXR, Physical Exam, OBGYN stuff, 2 sleep studies and getting a CPAP machine, and an ultrasound of my gallbladder. Via this I was diagnosed with sleep apnea, GERD, gallstones....blah blah blah.

The insurance will pay for that stuff since it is diagnostic. The results could actually make getting approval easier. Maybe get it done thru your PCP if you can and not via the surgeon if you are concerned.

Marlluvia · June 9, 2006

Thanks Medusa, that's a good idea. Maybe I'll try that. Thanks for the input.

Gracie

disneynut · June 10, 2006

Prior to submitting authorization for the surgery for insurance approval, my surgeon requires a psych consult and meeting with the nutritionist (both happened to be two meetings with each and post op nutritional counseling). I contacted my insurance company for preapproval on both of these. Insurance covers so many visits in a calender year. You need to speak with your health insurance provider. Once I got approved, then I went for blood work, urine testing, EKG, xrays, etc. and insurance paid for all of that.

medussa · June 10, 2006

Yes, my insurance paid for a psych consult as well. I did not get pre-approval. Never thought to.

Stesti · June 10, 2006

I am self pay and being banded on July 6th. MY pre-testing was picked up by my insurance. My tests totalled $2800. I believe my doctor sumbitted the tests as something other than pre-testing for surgery.