Blue Cross’s review of the claim was solely based on medical necessity. A pre-approval is not a guarentte of payment just a good indication that the claim when received will be a covered benefit under the plan. The pre-existing condition limitation condition is normally not reviewed in the process as this has no relation to […]
Written on Tuesday, July 15th, 2008 by shonholmes :: 0 comments to this post
Blue Cross’s review of the claim was solely based on medical necessity. A pre-approval is not a guarentte of payment just a good indication that the claim when received will be a covered benefit under the plan.
The pre-existing condition limitation condition is normally not reviewed in the process as this has no relation to the medical necessity. The medical director reviewing the case is just making sure that you jumpped through the 100 hurdles prior to obtaining the service.
Question-
Did you have prior coverage for the past 12 months with a seperation of coverage of less then 63 days?
If so, send the insurance company your “certificate of creditable coverage” as you have protection by the health insurance portability act.
———————
Did you have a pre-existing condition?
As defined as, knew or should have known that such condition required treatment within 6 months.
———————-
File an appeal with the carrier. If upheld at the carrier level, file a dispute with the Department of Insurance or Department of Labor depending on your carriers funding arrangement.
Post Comments Here » 0 comments to this post
Check the Categories below for more on Empire Blue Cross Blue Shield Question?
More from Uncategorized(t) Categories
« What is the Best Suburb In Northern San Antonio, Tx? Low Crime, Good Housing Costs, Education and Water….? :: I am interested in renting a car for my 10 day trip to Morocco.? »
