Wiki Secondary Insurance stating they require pre-auth's

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Peter Davidyock

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I just received this email. Does anyone have any information about secondary insurances requiring pre auths?

Hi Guys,

BCBS of NC Plans as secondary insurances are now requiring surgeries and procedures to be authorized with both the primary insurance and them as the secondary insurance. I only found this out by working a denial

Any insight would be appreciated. I am under the impression that a secondary insurance must process a claim the way a primary assigns it to them.
Thanks
 
I think you are thinking of Medicare GAP (Supplement) plans that will only pay if Medicare pays the claim. They typically do not have any pre-authorization requirements.

Commercial insurance carriers that are secondary simply process the secondary claims under the benefits and limitations of that particular plan. If the patient's secondary insurance has a pre-authorization requirement, then that requirement must be met in order for the claim to be paid. I always advised practices to check the benefits and authorization requirements for primary and secondary (even tertiary) plans, for this reason.

Hope that helps!
 
Thanks Jennifer,

These are for all intents and purposes trauma patients. No authorization takes place at the practice level. they usually ride on the hospitals primary insurance auth. I have a thought though about uniformity in the industry. If a secondary payer is requiring an auth and the number is different from the primary ins auth that creates an issue when the primary automatically crosses the clm to the secondary.
Any thoughts on that would be well received. I'll have to do some contract research on the legality of this.
 
Peter,

I hear you and totally agree. There are a couple of options you might consider:

  1. Talk with the hospital(s) and let them know that BCBS of NC has informed you that authorization is required, even when they are secondary. For trauma cases, the hospitals should be getting all required authorizations.
  2. Another option would be to talk with your provider representative and/or the Medical Director at BCBS of NC. Explain the situation and see what they recommend. Sometimes, they will make changes to the policy in light of these kinds of issues. Sometimes . . .
That is where I would start. Hope that helps.
 
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