johnmeyer
Guru
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.
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.