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Originally Posted by henry4956
I've talked to JasonHHH (I think that's his name) on this site. He doesn't post much. I did everything exactly like he did, I'm still waiting.
Concerning the Pre-Auth. Very debatable as to whether you should or should not. Jason did not and got 100% and I tend to agree. My reasoning is this: The one thing I keep hearing overtones about is 'Emergency' vs 'Planned' I think Pre-Auth proves planning. Again, no one seems to have the blueprint on this. I think if they deem that the surgery was planned then it decreases your chance for reimbursement. Obviously we all have to plan this but... I really think it's a hit or miss proposition - no rhyme or reason
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From what I'm gathering, it does come down to the emergency vs. planned. If it's emergency surgery then they will cover it. If you try to get pre auth, then it seems that they make you follow the regular guidelines of what types of surgery is normally covered. But I also agree that there doesn't seem to be any rhyme or reason. My policy just renewed and this year there is no penalty not getting pre approval. I'm just going to pay for it out of pocket & hope that there's enough to support that it was an emergency.