Post by Deleted on Jul 27, 2013 2:42:11 GMT -5
I need to find out as much as I can about single PAR provider agreements. I was supposed to have revision surgery and now need to transfer that approval to a new surgeon. I am asking my insurance company to make an exception and allow a single exception and pay the surgeon's fees for either Dr. Rabkin or Dr. Keshishian. Program fees are my responsibility and extra now, I know.
My insurance company is Aetna, who is of course dragging their feet and avoiding my calls. I finally tracked down my Case Manager, who sent me on to Pre-Certification, who said that I must speak with the nurse who approved my surgery for help in this unusual situation.
I am supposed to talk to her on Monday, and she is supposed to forward my situation to the Medical Director. There is some concern from the doctor's office that my approval will be overturned. Both of the new surgeons do open revisions, so the code is different. I wouldn't think that would be a big deal, but the doctor's office seemed concerned about that also.
I need help coming up with reasons that my insurance company will understand for using a vetted DS surgeon who is experienced with revisions and that will make them amenable to an agreement with one of the surgeons above for a single case exception.
If there is anyone here that has experience with this, please help. Thanks.
My insurance company is Aetna, who is of course dragging their feet and avoiding my calls. I finally tracked down my Case Manager, who sent me on to Pre-Certification, who said that I must speak with the nurse who approved my surgery for help in this unusual situation.
I am supposed to talk to her on Monday, and she is supposed to forward my situation to the Medical Director. There is some concern from the doctor's office that my approval will be overturned. Both of the new surgeons do open revisions, so the code is different. I wouldn't think that would be a big deal, but the doctor's office seemed concerned about that also.
I need help coming up with reasons that my insurance company will understand for using a vetted DS surgeon who is experienced with revisions and that will make them amenable to an agreement with one of the surgeons above for a single case exception.
If there is anyone here that has experience with this, please help. Thanks.
