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Re: Is this a new "con game" by Insurance Companies?

Posted by addy on March 11, 2001 at 13:37:25:

In Reply to: Is this a new "con game" by Insurance Companies? posted by sean on March 11, 2001 at 09:51:27:

Sean,
I do the pre-cert. process for an orthopedic rehabilitation dept. and that one gets me, too. "No pre-cert. but based upon med. necessity." So, we treat and then if they decide it isn't medically necessary, we don't get paid and the patient gets stuck with the bill?
At least with pre-auth. or pre-cert., the provider is allowed to treat the patient for X number of visits as determined at time of precertification. This no pre-cert. but med. necessity business does appear awfully arbitrary, doesn't it? It leaves it to the provider to know every iota of the criteria for a procedure to be determined as med. necessary and believe me, every provider isn't so up on that.
Addy

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