Preauthorization for Surgery Not Being Delivered to my Insurance Co in Timely Manner?

The office of my PS said they were submitting my preauthorization for a breast reduction with my insurance on Feb 21. It's now March 1 and my insurance co says they have absolutely nothing on file for me. What gives? It's been 10 days, certainly they should at least have on file they've received my information and its in review. How do I handle this blurb with my PS's office?

Doctor Answers 4

Breast Reduction - Insurance Coverage; Preauthorization

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Each surgeon and practice has its own policies and procedures.  When I submit a preauthorization request, I do so via US Postal Mail using Certified mail and a Return Receipt.  I mail a copy of the letter to the patient, and can include copies of the receipts for the mailings if requested.  So that takes care of Step #1, which is getting the request to the insurance company. 

Next, though, you have to ensure that the company has received the documents that were mailed.   Despite everyone's best intentions I have seen cases where the documents got to the mail room but apparently not beyond.  So in that case they have to be resubmitted.  You may need to contact the insurance company yourself and make sure that the documents are faxed or emailed to the people in question.

And at that point you can address the specifics of the preauthroization request.

Sometimes this process goes smoothly and quickly.  And sometimes it doesn't.  And that's where you would need to step in to help it along.

I hope that this helps, and good luck.

Dr. E


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Preauthorization takes time, often several weeks.  Give it another few weeks and if you haven't heard anything by then, give the surgeon's office a call.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Breasts Reduction and Pre-authorization?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the question.

I am not at all surprised that your insurance company does not have anything on file for you after 10 days. You will find that the process will take several weeks/months to be “on file”, reviewed, and returned to you and/or your plastic surgeon's office.

Patience and persistence  are important when dealing with insurance companies and the preauthorization process. On the other hand, it is very likely that your persistence will pay off; breast reduction is one of the most patient pleasing operations we perform.

Best wishes.

Insurance for breast reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Welcome to the world of insurance companies. This happens in my office quite commonly. Even though the appropriate paper work is submitted as requested by the insurance company many times they "seem to have lost it " or can not locate it.  You may need to help your doctor's office with this situation.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.