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Do doctors in Pennsylvania have to preauthorize your insurance before any surgical procedures?

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2009-11-07 22:16:58
2009-11-07 22:16:58

Different insurance companies have different precertification requirements. Some companies only require precert for inpatient surgeries, however others require preauth for all surgical procedures. This is not a state mandated law, it is specific to each insurance company. You can not be penalized if your doctor neglected to precertify your surgery. if you had a surgical claim denied for no precertification, you are not responsible for the balance as long as you did your part as outlined by your insurance company.

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Not always true... With some insurance companies it states in the members handbook that they are responsible for obtaining authorization. If it is not obtained then the doctors claim will be denied. If the situation isn't rectified (say, by a retro review) then the office will bill the patient. If the surgeon is par with that insurance they are usually pretty good with calling and getting procedures precertified.
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