Anybody else heard of prior authorization?

ali_sha006 · May 2010

I didn't know anything about this untill my mom was going through my insurance policy information and mentioned it. My plan doesn't specify whether I have to do it for pregnancy or not, but apparently I have to authorize with my insurance company that I will be having a child or something along those lines. I'm going to call the company tomorow but just wanted to mention it in case you ladies didn't know anything about it. My mom said she didn't do it when she was pregnant with my sister and she was penalized 20% of the bill or something like that.

KRB8 · May 2010

That's really interesting. I'll have to look through my plan again to make sure I have everything squared away.

Thanks!

AML84 · May 2010

Yes, BCBS has a number that you must call before you go into labor and let them know.

cookieinva · May 2010

I'm sure every insurance is different. I had foot surgery last year and had to get pre-certification for it; my insurance does not require it for labor though.

Legally Nads · May 2010

Hmm.. I'm not sure about that. I do know that most insurance companies want you to "pre-authorize" your planned hospitalizations (planned c-section or induction), and if you are hospitalized for emergency (unplanned) then you have to call and let them know within 48 hours otherwise you will be penalized. Maybe this is the same thing?

susie985 · May 2010

I have heard of that, but thanks for reminding me. We have HAP, I don't know if they have a policy on that, but I told DH to check into it.

davidandmickey · May 2010

Good point; hadn't even thought about it! I've always been told to call the insurance company and verify things before any procedure - make sure you don't need pre-authorization or need to go to a particular facility, etc. Thanks for the advice!

queenofkings76 · May 2010

We have BCBS of Michigan and I don't believe we have to do this.

kg_08 · May 2010

I know with my insurance company I was advised to tell them when I got pregnant... I think I would have had a fee if I didn't, but every insurance company is different. Definitely worth it to call!

jcthomas1281 · May 2010

my insurance says they need these forms within 24 hours of admission. I believe I just filled them out at my last appt where I filled out the authorization for c-sect, vaginally delivery and blood transfusion...all the good stuff

HayleyandMark · May 2010

I had heard of that so I called and told my insurance and the woman said she would mark my file or something along those lines.

noliablue · May 2010

Yep... We had to do it. We ended up calling too late and now we have to pay an extra $400.

janeyjane17 · May 2010

noliablue:
Yep... We had to do it. We ended up calling too late and now we have to pay an extra $400.

That is effing ridiculous! I hate how insurance companies make up rules JUST so you have to pay them more money. It's not like you don't already pay for premiums, ya know?

JulzRulz · May 2010

My hospital preauthorized with my insurance co after I pre-registered. Then they sent me an estimate of what it will likely cost us after insurance pays. You might ask your hospital if they will do it for you.

Laura0575 · May 2010

Yeah, we got something in the mail that looks like our doctor already did all this for us.

ColieJ · May 2010

??? You would think they would have a clue when the OB authorized initial care!

Luckie519 · May 2010

I am sure that every insurance is different, but I have BCBS and I have called them several times to make sure that I do not need to "pre auth" or call before or immediately when I am admitted to have the baby. The lady I talked to said that she had never ever heard of anything like that.

She said that once they start getting claims from the hospital, it's obvious you are there to them, so they don't need the call.

Like I said, I have called several times to ask about this and have gotten the same answer each time. I even got reference numbers for each time, so hopefully it's taken care of.

Teagiedo · May 2010

I did pre-register at my hospital and they in turn contacted my insurance and got my copay amount. I am so excited because I only have to pay 100.00 for the birth of Bradley. That's the cheapest thing I probably will be paying for him. Good luck

Olivia921 · May 2010

I would suggest that everyone call their insurance company and see about pre-authorization for your baby once he or she is born. My daughter needed to be observed because I had a fever when she was born. This ended up costing us several hundred dollars because it was not pre-authorized through our insurance. This time I am calling and making sure of this before I go into labor.

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Anybody else heard of prior authorization?

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