If the hospital received an authorization for admission shouldnt that cover the physician services (ie surgery)? we keep receiving denials from UHC where patient was admitted but the surgery codes themselves were not on the auth and therefore denied. appeals rarely overturn the denial. It was not elective surgery in that patient's were admitted via ED room etc.
Any recourse?
Did the procedures that are being denied require prior authorization themselves? An approved PA for an inpatient admission, assuming that it was not converted from IP to OBS, would only be for the IP admission and doesn't necessarily include all procedures performed.If the hospital received an authorization for admission shouldnt that cover the physician services (ie surgery)? we keep receiving denials from UHC where patient was admitted but the surgery codes themselves were not on the auth and therefore denied. appeals rarely overturn the denial. It was not elective surgery in that patient's were admitted via ED room etc.
Any recourse?
We are on trauma call at our local hospital and we bill our surgery charges under the hospital's authorization number and just mark the claims emergent. We haven't had any issues with getting our claims paid by other insurance companies. We terminated our contracts with UHC so we rarely have to deal with them anymore.The IP stay was authorized. The later is the issue, the surgical codes werent called in or linked. We are encouraging MD's to notify their offices so separate auths can be called in but it is an uphill battle