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My case is little bit different. I initially was planning to do Heller and i got the approval as well. Few days before surgery after meeting with my doctor, i decided to go for POEM. Doctors office said they sent the necessary documents to their pre-cert department to get the approval for POEM on July 10th. I followed up with the insurance after few days and came to know that surgery date has been updated for Aug 11 but the procedure code was same as for Heller. I became nervous and called doctor office on July 21st and they said my POEM has been approved. I mentioned what my insurance said but they said not to worry about - both procedures are myotomy so insurance might have got confused. I persisted with my doubt and had the pre-cert of my insurance talk with pre-cert of the hospital. They finally had the new code for POEM added to my case on July 28th. I even called my doctor's office asking for the code and at that point the lady flipped. She just hung up saying " I don't know about the code." On July 31st, the pre-cert department of my hospital and my doctor's office were notified that the new procedure code was denied. I haven't heard anything from my hospital and it is august 2nd. I found all this information from my insurance. Now I am really not sure what to do. surgery is still scheduled for 11th and I don't know what the doctor's office is thinking not telling me about this.
Does anyone has any suggestion on what to do if your POEM gets denied in 1st place on pre-authorization request?
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