Pre-approval got skipped

I had a minor in-office procedure done at my skin doctor’s office.  I am now learning that the doctor’s office did not go through the hoops to have my plan pre-approve the procedure.  What happens now?  Will the plan “post-approve” it?  If not, who is stuck with the bill?

Warts and All

Dear Warts and All,

Your plan will most likely refuse to pay for the service, if the pre-authorization was not given. The plan is not required to post date an approval and pay the bill, even if they would have approved it had it been submitted on time.  You will be billed for the services. You could try to get the provider to reduce the bill, or even to forgive the cost, based upon the provider’s having shirked its responsibility. Legally, however, you are on the hook for the cost of services.

Whenever you are having an out-of-the-ordinary service, it doesn’t hurt to ask the people at the front desk if your plan has been called.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.