The Games They Play

I had to call my health insurance company yesterday for preauthorization.

Interesting concept really. I pay for coverage. That coverage includes certain benefits. But in order to get those benefits paid for, I have to get my insurance company’s ok in advance. Who exactly at that insurance company has the knowledge or expertise to say yes or no to a service or treatment my doctor and I decide I need? I know the woman who took my call yesterday isn’t a medical professional. She’s a customer service representative. In the preauthorization department. She inputs data and doles out codes. She is not in any way, shape, or form qualified to make medical judgments.

That all said, getting the approval I needed yesterday was easy enough, but there’s an interesting catch clearly designed to trip up customers and save the insurance company money.

Here’s how it works. You can get preauthorized for SOME of the service or treatment you need but not all. You have to check in after a certain amount of time and get their ok for the next batch of benefit allotment. And if you don’t call in at just the right time and there’s any gap between your last approval and your next approval, tough luck. You have to cover the interim claims out of pocket. Even though you’ve already paid for the right to the service or treatment as part of the benefits package you’ve bought.

In the immortal words of the Connect Four kid, pretty sneaky sis.

Leave a Reply

Your email address will not be published. Required fields are marked *