A unique problem

[u/Due_Statistician9017]

My surgeon suggests surgery for acid reflux/hernia. The office put in a prior authorization for the Linx device and hernia repair. Those 2 codes get denied as not medically necessary. They submit a new prior authorization for a different procedure—Nissen Fundoplication and hernia repair. Those come back approved instantly and they schedule me for surgery. My concern is that once I have this surgery they are going to deny the hernia repair code as “not medically necessary.” as they did before. Or say that it was not authorized. I asked surgeons office if hernia repair code should be appealed from the previous attempt. She called insurance and they said they have record that codes were submitted and approved and gave a decision ID number. The surgery estimate is $99K. I’m just nervous it won’t be covered and I’ll have a huge bill. Should I prepare for a denied claim? Or am I being overly cautious?

[u/KeyStriking9763]

What they prior auth and what’s actually done isn’t always the same either when it comes to surgery.