pvacanti
Networker
Hello! I'm trying to figure out how other specialist offices who round on and accept consults from the hospital and end up doing surgery obtain prior authorizations from insurance companies that require an authorization for the surgery. By the time the charges for the consult and surgery make it back to the office we are already past the 72 hours window that the insurance company will allow a retro authorization. I feel that because we are being requested to consult the patients by the hospital and the patient was in a observation status the insurance company should not require a prior auth for the surgery because it wasn't an scheduled in advance. I hope that makes sense Is anyone else having this issue with denials by insurance companies for no authorization on a patient that was admitted to Observation at a hospital?