In 2023, my wife had surgery. She was informed that the procedure was authorized and that she was covered. We got documents today that appear to indicate they have rejected post-procedure coverage. Is that anything that exists?
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Was the provider in-network?
Did the provider obtain pre-authorization before the surgery? If so, what does it specify?
Who informed you that it was covered, and what was the explanation?
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Seems to suggest? The specifics matter a great deal in this situation. Ask your insurance company over the phone. Make no assumptions.
In-network provider They completed a pre-authorization; I will have to find out what that states. Since it was about a year ago, I must review the documentation.
We were assured it was covered by the doctor’s office.
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Yes, you should be aware of what it says since it will affect your selections. When did they refute it, and what justification did they give?
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All they did was deny it. We were given this gadget to take home. said there was no medical need for it.
If your coverage was refused after a procedure, review your policy details to understand the coverage terms and reasons for denial. Contact your insurance provider to appeal the decision or request a detailed explanation. Consider seeking assistance from a healthcare advocate if needed.