Getting Pre-Authorization For Insured Health Care Services

[MikeeW]

I know this is a shot in the dark, but hope some member will have experience about this.

I wanted to know what sort of process was used to get pre-authorization for a health care service, specifically, a US-based insurance (Mail Handlers Benefit Plan). The authorization pertains to exams such as CT or MRI procedures.

The MHBP requires a telephone call to be made, but offers not specific instructions such as who makes the call, when (office hours) or whether their secure website can be used.

MHBP has no in-country support. It is hit or miss with some doctors here as to whether they will make the call.

For some insurance companies, here in the Philippines, the process is simpler as a call is made, a form is provided to the physician who fills it out and provides it to an in-country rep.

Any advice?

[MikeeW]

Another member suggested I add some info to this post.

The MHBP is a US Federal program and intended for federal employees and retirees. I've had this plan for over 30 years. They are allowing overseas doctors and institutions to be considered as "preferred providers" which essentially means, they will allow most charges as they end up being cheaper than any US costs. Unfortunately, they have no "handlers" here.

In 2013 they are expanding their list of procedure requiring pre-authorization. In 2012 this included MRI, CT and a few like that. In 2013 they are adding a long list of procedures and therapy requiring pre-certification (chelation, certain drugs, genetic testing, spinal surgery and many more) .

I was advised that maybe some caring soul at American Citizen Services may have some knowledge of the process (even have the same medical insurance). My problem is getting in contact with them. Whenever I call, I usually get a bureaucratic reply from a local who is not familiar with the details. They are acting as gatekeeper to the ACS staff who may actually have the answer or advice. Kinda like the security guard who won't let you in unless he is convinced you have real business.

I would love to use email if that is an option. At least I can spell out my queries and hope for a response.

Edited November 27, 2012 by MikeeW

[Okieboy]

Well i have heard also that in the new health care bill here are provisions for off shore payment of Medicare and other Gov Insurance, but i don't know if anyone who has first hand information, the Citizens of Guam and other American islands can use their Medicare in the Philippines in certain situations, the Senator from Guam got this approved, there are going to be a lot of changes in the Health Care and Health Care Insurance in the next 2 years i would not count on anything just yet, i have Medicare A & B but have not used it , i go to the VA, i am waiting untill this health care bill kicks in and than decide if i should keep it or not, if you are issued a voucher to buy private insurance maybe there is something there for a company in the Philippines, untill than just hope you don't need it.