Implant approved by insurance

[Gt1956]

Fyi, approving is not the same as covering the procedure.
Sil got approval for a knee surgery. Come to find out, when her employer was bought out her name was dropped from the company employee insurance plan. Payroll had even been withholding the premiums.

Agreed. Thats the reason its very important to make sure its is indeed covered and approved. In my case it was approved in writing and I have coverage through my employer. So my situation is different. If its not a covered procedure how did they issue a preauthorization with a code etc?

This was about 20 years ago. She had insurance through her employer. Premiums were taken from her pay. Apparently she was not on the list of employees sent to the insurance company. I'm guessing that her payroll people just paid the premium they was billed for the people on the list. Looks like nobody ever cross checked the lists. Including the insurance when they gave the ok for surgery. The key point to my comment is that insurance can ok a surgery for someone that they don't cover. That does not mean that they'll pay the claim of a non covered person.
The employer paid the bill in increments on the sly. This wasn't a ma & pa place, Berkshire Hathaway bought them a few years later.
I think we have a member whose insurance has declined to pay for an implant that was approved. Not sure of his story but definitely a similar occurance.

[Badspartan]

I received an email that they will pay for the implant

[bionicbrother]

This was about 20 years ago. She had insurance through her employer. Premiums were taken from her pay. Apparently she was not on the list of employees sent to the insurance company. I'm guessing that her payroll people just paid the premium they was billed for the people on the list. Looks like nobody ever cross checked the lists. Including the insurance when they gave the ok for surgery. The key point to my comment is that insurance can ok a surgery for someone that they don't cover. That does not mean that they'll pay the claim of a non covered person.
The employer paid the bill in increments on the sly. This wasn't a ma & pa place, Berkshire Hathaway bought them a few years later.
I think we have a member whose insurance has declined to pay for an implant that was approved. Not sure of his story but definitely a similar occurance.

Thats terrible.. Insurance companies try to not pay and providers try to make sure you pay.. its win-win for insurance and provider and the only losing party in this transaction is the patient..