Ack! Anesthesia was denied post-op, now what?

[MelBooks 76]

We just got a bill from the anesthesiologists that my claim was denied. We have Aetna and used one of their "Center's of Excellence" and my surgery was approved with no problem. The exact same anesthesiologist did my endoscopy and it was covered. What should I do now? It's a rather big bill that we were NOT expecting.

[Recycled 2,182]

Calm down. Sounds like a mistake. Call them and speak to someone in authority. It that doesn't work inquire about appealing the denial. Keep pushing until someone listens and or approves it. I wouldn't pay anything. They all approved it before, so I would keep rubbing their noses it that approval until they succumb.

[Luvin_Life125 558]

Call Aetna first thing tomorrow and discuss these charges. The charges are called "runaway charges" and should be covered and paid as in network even if the provider isn't in network with your plan. All you should have to do is explain you had no control over who did the anesthesia at an in network facility. It should only take one call to straighten it out. Please feel free to message me if you have any more questions. I spent many years as a billing manager for a private medical practice and might as well put my knowledge to good use!

[MelBooks 76]

Ok, I think we've got it all worked out but man, oh, man did I have a panic attack in the process.

I called my surgeon's insurance coordinator and she said it was really weird for the claim to be denied and that she'd look into it. Then I get a call back that the entire surgery was DENIED! Holy crap. I had pre-approval and did everything right, and the only thing the coordinator could think of was that I got my approval on 12/20/13 but didn't have surgery until 4/9/14. Perhaps that coverage was dropped on Jan 1st or something.

She called the insurance company and thank goodness they said something had gone wrong on their part. The claim was resubmitted and it went through just fine. But for like 45 minutes I thought we were suddenly going to have to come up with 25 grand!! I'm still waiting to hear back from the anesthesia group to make sure their resubmit went through but seriously, now I need BP meds!