Medical Billing Forum

Billing => Billing => Topic started by: jcfenfen on February 22, 2010, 12:43:55 PM

Title: Authorization before office visit
Post by: jcfenfen on February 22, 2010, 12:43:55 PM
I called Blue Cross regarding their authorization, and they say for outpatient they require authorization 5 days before the patient comes in, so how is it possible to obtain authorization before the appointment if the patient just called the day before the appointment?  If the insurance denied the claim on the ground that authoroization not obtained, how to make an appeal for it?  Thanks for any advice
Title: Re: Authorization before office visit
Post by: Pay_My_Claims on February 22, 2010, 03:08:09 PM
outpatient what??? technically an office visit is outpatient

if you work in a specialty clinic, you should be aware of the procedures you perform and the requirements of the insurance plan. it should have been verified and if it required prior auth, the client should have been notified that she would have to pay up front or reschedule until they are able to obtain her auth
Title: Re: Authorization before office visit
Post by: Michele on February 22, 2010, 06:18:08 PM
Wow!  I've never heard of having to get an auth a certain number of days BEFORE an appointment.  That's a tough one.  I've heard of having to get the auth before the appointment, but not 5 days!  But if that is truly there policy I'm not sure you have an appeal.  Unless there was a medical reason the patient couldn't wait 5 days.

Michele
Title: Re: Authorization before office visit
Post by: rdmoore2003 on February 23, 2010, 02:38:40 PM
I agree with Michelle on this one.  I have never heard of a specific day prior to appointment.  However, we are talking about blue cross blue shield.  I have had days that I can speak with the insurance company 10 times in 1 day with the same question and get 10 different answers.  You just have to dig.
Title: Re: Authorization before office visit
Post by: Michele on February 24, 2010, 01:29:24 PM
Had lunch with a BC rep the other day.  Things are tough right now in the insurance biz and I'm surprised they can afford to be so tough.  I would think that could cause them to lose business.

Michele
Title: Re: Authorization before office visit
Post by: Sportsmom on February 26, 2010, 08:38:13 PM
I know that some offices ask for the patient to give them 5 days to process an authorization to the insurances companies. 
Insurances companies may say it will take 5 days for an authorization to be processed if it has to go to medical review.
Title: Re: Authorization before office visit
Post by: PMRNC on February 27, 2010, 01:19:32 PM
No they don't tell you days before, they however may give you 24-48 hours to obtain the auth after the visit. I've never seen a carrier want 5 days PRIOR to the auth.. that's not fair, what if an appt is available that day or sooner? I think you might have misunderstood.