December 2009
Endometrial Ablation Requires Prior Authorization after January 1, 2010
Beginning Jan. 1, 2010, BlueCross BlueShield of Tennessee will require prior authorization for endometrial ablation, a surgical procedure performed to reduce or prevent uterine bleeding. Post-procedure reviews have determined that about 60 percent of the procedures are not medically necessary, according to BlueCross medical policy.
The prior authorization requirement will improve service to our members by informing them about the medical necessity criteria in advance of the procedure. Members who have the procedure from an out-of-state or out-of-network provider will be financially liable if their post-procedure claim is denied.
Your groups will receive notification of this change in the next group administrator newsletter and the prior authorization list in the member section of bcbst.com has been updated with this new requirement. |
