r/sterilization • u/TitlessInTahoe • 5h ago
Insurance No Pre-Authorization Required?
So I was able to get a bi salp set for 9/15, the doctor's appointments were a breeze but insurance is a little difficult as usual. After a slew of phone calls today, I verified the codes the hospital gave to insurance were correct (58661 & Z30.2), I was able to get an insurance rep to verify that my plan (PERS Platinum PPO Basic/Blue Shield of CA 2026) covered this procedure in full under these codes as 'Preventive Care' and obtained a 'reference number' which they said was only the current date you called plus their first name and last initial (no idea if that's true), and also verified that my plan was ACA compliant and my surgeon and health system were in-network.
Hospital financial dept is still saying I owe ~$4k, but I was like nah, I rummaged through my plan's 'Evidence of Coverage' and 'Summary of Benefits and Coverage' docs and pinpointed language verifying that my plan is ACA compliant and that my plan covers 'sterilization procedures' in full w/o cost-sharing and before my deductible is met (the deductible I honestly wouldn't mind paying, it's almost through).
When I asked about pre-authorization, the hospital said they received a letter from my insurance specifying that it wasn't required for this surgery. The assistant I spoke to submitted the request again today, and received yet another letter stating that it wasn't required, which she graciously sent a copy of to me.
At this point the only thing I have left to do is call my hospital's financial dept back tomorrow to see if they'll accept my 'reference number' from the agent I spoke with today. I had asked the hospital rep if there was a way to specifically request the authorization, but she reiterated that the (2nd) denial letter indeed means there's nothing else. I at least have a copy of it for my evidence file I guess. But I'm definitely expecting to fight after everything is done.
Has anybody ever dealt with insurance saying pre-authorization isn't necessary?
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u/goopstastic 4h ago
I just had my bisalp done a week and a half ago. The surgery scheduler told me no pre-authorization was required. The claim went through my insurance yesterday and was paid in full!
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u/TitlessInTahoe 4h ago
Congrats on the bisalp! I'm nearly at the end of my journey for one. Thanks for chiming in, it really helps
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u/Cutthroat_Rogue no more tubes 10-15-25 4h ago
Pre-auth was not required for me. I've actually never had to deal with a pre-auth for anything with my healthcare.
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u/TitlessInTahoe 4h ago
Sounds like a dream honestly! Only reason I feel even slightly confident is b/c I have physical proof that they (seemingly) don't require it in case they come back to say they do.
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