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How long should it take an M.D to submit a claim to my insurance company for prior authorization for a breast reduction?

Q:

In October, 2012 I saw a plastic surgeon for a breast reduction.  Three months later I called the doctor's office to check on the claim for the breast reduction only to learn that the doctor HAS STILL NOT sent it to my insurance company.  A doctor friend of mine said this is really unprofessional of him to wait so long.  Is this normal? How long after the initial consultation does the doctor have to send in a claim?  Once he gets approval, what is the time frame for him to do the surgery?

A:

It should not take that long. Put the call in to the office manager and see if you can get them back on track. I am sure it just got put into the wrong pile and no one is looking at it. It helps to advocate for yourself in a situation like this one.

Approvals are usually good for 90 days but can be renewed. Typically once an authorization is received, the operation should be scheduled. Billing of any encounter is usually done immediately, but the physician has one year to submit (in California).

I hope this helps!

Jay Calvert, MD, FACS

Jay W. Calvert, M.D.
Beverly Hills, CA

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