Frank,
I'm picking up what you're laying down...brief, but detailed and easy to follow. Don't make a story out of it. Give them a patient history that leads to the surgical decision. Key words to them.....MEDICALLY NECESSARY. Show them you didn't just jump on surgery, and you should be fine. The doctor's letter of medical necessity should outline the fact that you do have a defect present that can cause your symptoms and the doctor's surgical treatment is what he performs to treat those symptoms.
You're saying to outline your conservative treatments prior to surgical intervention...but don't include all the extensive paperwork because they should have that on file ?? That's a good idea....the actual documented history would be more suitable for an appeal i believe as well.
I never really got any sort of official pre-authorization. I first confirmed that i do have BlueCard WorldWide coverage on my plan. I confirmed this with BCBS at home, and with BCWW ( both on voice recorder)...i couldn't risk dropping 63,000 bucks and then finding out, OOPS! You're not covered for that type of care outside the United States. Coverage can vary greatly, some people might only be covered for medical emergencies when traveling. I don't recommend anyone doing this without first verifying it. You don't need to go into specifics, just ask if all of your benefits remain the same if you were moving or traveling outside of the country.
Only this last call i made to BCWW did they issue me a case #. I called them to get a final decision on where i should send my paperwork, since i got 2 sides to the story before. I told them i had already scheduled a surgery date and made my self-payment in full. Pre-authorizations usually involve setting up direct billing with the hospital (which they DO with Quiron), but I let them know that i was instructed to make full payment prior to surgery and would need to submit for reimbursement. They were perfectly OK with that, and were adamant that the paperwork needs to go to them first. My situation feels more like a "pre-verification" than a " pre-authorization" since i had already scheduled the surgery and made payment. Whatever i have done, they will cover what they are going to cover, regardless if i kept my mouth shut and just laid the paperwork in their lap.
