Can you guide me to find any sort of legal back up PPO's have to obtain preauth or I'm not liable?

Whoever provided the treatment, if they are a member of the PPO, in their contract with the insurance company, they have a clause that says they will get auth or they will not bill you. I have, in the past, asked to see a copy of the md's contract, found the clause and pointed it out to them- but need to know what kind of service...If you were an inpatient at your member hospital, they MUST get auth- they know this- Please check to see if your state has a dept of managed care. If not, you need to file all of the info regarding what happened with the Insurance Commissioner.

If there is a Dept of Managed Care, file with them. Then you need to tell the provider who is billing you that you have filed a complaint. Also, your doctor can ask the ins co for a retroactive auth.

They need to submit the records to show that it was medically necessary and help you appeal the ins co decision. Was it a medically necessary thing? For example, most plastic surgery is not medically necessary, so that would be an exception.

Sorry- I don't have enough info to give you really specific advice, but would love to be able to help you. Hub Pages will send me an email with any info you provide and I will email you back. This will be confidential...

Jillian, I'm sorry I can't seem to find a place to message you. Email me at mamalonglegs2995@hotmail.com.

I cant really gove you an answer,but what I can give you is a way to a solution, that is you have to find the anglde that you relate to or peaks your interest. A good paper is one that people get drawn into because it reaches them ln some way.As for me WW11 to me, I think of the holocaust and the effect it had on the survivors, their families and those who stood by and did nothing until it was too late.