$25K in the hole

[Guest]

Claim denied after the surgery because I didn't have the procedure done at the preferred provider hospital

Received a disturbing phone call today from the hospital where my procedure was performed. They said because the hospital was not on the preferred providers list with BCBS. The claim was denied AFTER the surgery was done, even though they initially approved it. They hospital asserts I should have had it done at the other hospital in town which is the preferred provider. Prior to my surgery when going over all the paperwork, most of which was the information of all that could go wrong...like dying in surgery, I came across a waiver form which was explained to me as a document that would alleviate any residual costs incurred by having the surgery completed at the hospital I had the procedure in.

The surgeon was more amiable to this non-preferred hospital because they possessed the "Davinci" Surgical System. From Davinici's website:

"With the da Vinci Surgical System, surgeons operate through just a few small incisions. The da Vinci System features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human hand. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision and control."

So my logic says, "he's the doc that's going to be opening me up; I want him to be as cool, calm and collective as possible. If he likes using robots...then the doc gets his robots!" The office staff advised me that my plan did not recognize this hospital as a preferred provider, HOWEVER, they handed me a waiver which I read through and it stated that if the insurance denied any parts of the claim because of having the operation done at a non-preferred hospital, said non-preferred hospital would write off the costs in favor of the surgeon's preference for operating there. So I signed.

Seems to me $25K isn't a partial denial. It seems to me they denied the whole thing. I seriously hope they don't think I am paying that amount. I told the collections agent that I have an ex-wife collecting child support so they need to take a number and get in line. You can't get blood from a stone and if this goes worst case scenario and I get sued and wages garnished, I have no quarrels with quitting the job and working under the table since I only have a year of child support left. I did all that was asked of me from the insurance pre surgery requirements to the medical staff's pre and post requirements...to the letter. For this to happen now will be financially tragic...for them not me...

[camony 33]

I had something similar happen to me.. when I had my lap-band done... I didn't get my denial until after the surgery... I don't even get how this is possible after the fact.. I don't understand how they can approve something and then deny it... In my case only %30 of the bill was covered... My surgeon actually ended up eating the cost and The hospital was not allowed to bill me. I still don't understand it all... good luck to you

[Guest]

@camony

I'll update when I get a confirmed resolution.

[Bugaboo77 18]

OMG...same happened to me.
I was prior approved by insurance to get my band removed and now my insurance is saying they won't pay.
I sent in an appeal and they denied it again. $18,000. I have a message into my surgeon and my primary care clinic.
I am scheduled for RNY bypass surgery on July 10 and supposedly approved for that also. We will see!

[Edavis1124 3]

OMG...same happened to me.
I was prior approved by insurance to get my band removed and now my insurance is saying they won't pay.
I sent in an appeal and they denied it again. $18,000. I have a message into my surgeon and my primary care clinic.
I am scheduled for RNY bypass surgery on July 10 and supposedly approved for that also. We will see!

They approve bypass revision but unless there is a complication with the band won't take it out. Insurance companies are stupid some times. They paid 47000 for mine. Double what private pay pays. Talk about abuse of the system.

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