Wiki Referral / authorization

[johnmeyer]

I have a question concerning HMOs and specialty office visits.

I've heard that most insurances will not honor a prior authorization for a specialty office visit that crosses years.

For example:

A patient has 3 authorizations with valid dates of 11/30/2018 to 02/28/2019. She comes in for an appointment on 12/05/2018 and uses one authorization. She comes back on 01/18/2019 for another office visit. Would any insurance carrier deny payment for that visit on 01/18/2019 due to an expired authorization?

I already know that the VA would honor that authorization in January 2019, but I wanted to know if anyone here knows if any other insurance carrier would as well. I don't want to make a bunch of PCPs mad because I'm sending all these requests for updated office visit authorizations when it's not necessary. That and requesting/tracking all of that is hard for me since I'm literally 50% of the entire billing department at my clinic.

 

[t.b.townsend09@gmail.com]

how many visits are being requested on the authorization? and as far as I know if an auth is expired the claim will deny if auth is needed. I didn't quite understand entirely your point. hope this helps.

 

[heart123]

authorization comes from the insurance company
referrals come from the pcp
referral should have the dates on it and how many visits
if the date is expired you need to call for another referral
hope this helps

 

[johnmeyer]

Sorry for the confusion.

It's my understating that not all insurances will honor an authorization that crosses years.

For example....

The authorization start date is 12/07/2018 and is set to expire on 03/07/2019. The patient comes in for a visit on 02/14/2019. I'm concerned that an insurance company would deny payment in such a situation due to an issue with valid authorizations.

I know it sounds odd that an insurance company wouldn't honor an authorization they have issued, but like I said, it's my understanding that some will.

Hope that clears things up a bit.