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Old 07-02-2005, 06:14 AM
Rein Rein is offline
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Join Date: Apr 2005
Posts: 265
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J - When you're dealing with issues this important it's always a good idea to get the complete name and position of the person providing the information. At the very least you then have either corroboration or someone to point a finger at when you receive conflicting information from some other source. Kim's absolutely on the mark; get it in writing!!!

As to the details of authorization, each BC issues a Member Handbook (which is *not* the contract) which spells out most details. Also important to obtain and read through thoroughly is the Benefit Description (which *is* your formal contract). You probably will have to ask your plan sponsor or employer (or whoever you get your insurance through) to provide a copy of the Benefit Description, which is the legal document that describes your coverage. The details in the Description are more extensive and need to be read and understood because they are the final, definitive answer as to what services are provided (or not).

Speculation here, but I wonder if the BC authorization for the procedure that Julaine mentioned might not be the change we've been expecting as of July 1, i.e., the new procedure approval codes. Prior to yesterday there were no approval codes for ADR and surgeons' offices were using other codes to enable these procedures. Of course it could just as likely be simply some dimwit in the doctor's office thinking about some other insurer's policy or something equally as mundane.
__________________
03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
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