My Doctor is submitting my paperwork for Prior Authorization today!!

[DesertGal]

I got a call today from my surgeon's office and she said she was going to submit my paperwork for prior authorization, but when she called BCBS FEDERAL they told her I had Medicare Part A & B. (I have A, hospital only, which I told her). She said I needed to call BCBS and ask what they have on file and to get back to her.

I called the insurance and the gal I spoke with said I have Part A as primary (for an inpatient stay). She said if you are admitted for inpatient, then you have to use your PART A and that there is no pre certification required from BCBS. I told her that I would be staying overnight and she told me that sometimes if you are kept overnight, it may not be considered admitted, and that the term used is under "observation." OK??? She then asked for my surgeon's number and had me on hold. She came back and said she spoke to the woman she needed to and explained it all.

I then called the surgeon's office to touch base and she told me she wanted to submit the paperwork as inpatient, because the hospital would give her a hard time otherwise (seeing they do these surgeries often and know it's not outpatient.) And yeah, I do not want to be given the boot before I should! She said she was submitting the Prior Auth to my insurance anyway, even though they don't need it. Better safe than sorry.

[Christie13]

Well that was all confusing but seems like it means you will have no issues being approved for surgery, right? Just making sure I read what I think I read. Congrats!

[DesertGal]

I was confused myself at first. The office gal at the surgeon (his sister) was saying "your insurance says you have Medicare A & B for primary, you need to talk to them to see what you have." I told her I have part A hospital only. Then she said something like "I don't know how that'll work.". I was thinking "What? So I have hospitalization, in addition to my primary insurance bcbs federal." When I spoke to bcbs moments later, even the rep there said the same thing as I thought. That's when she said if it's outpatient Medicare doesn't get involved and my surgeon wouldn't even need a prior authorization. I told her it IS inpatient and then she told me about the terminology: if I stayed overnight under OBSERVATION, then Medicare isn't involved.

My surgeon's office told me after the insurance call I made, and the insurance gal called them too, that she still wanted to submit how it should be... for prior auth. I wasn't stressed out either, shockingly! I see the nutritionist in a group a week from today (final time) and I see the Dr again the following Monday. I don't know how long the paperwork part takes. We shall see.

[Luna354]

HOpe the rest of your approval goes smoothly!

[Nitasjourney]

Hopefully all is figured out for your big day

[ghost_ryder]

Stop, my brain hurts now.

[DesertGal]

I'm not sure why the surgeon's office was getting excitable. BCBS FEDERAL seems to fine. And Medicare Part A is just for a hospital stay. (Extra coverage as inpatient, as I see it.)The surgery is covered under my health insurance.