Insurance said covered but....

[DelawareWoman 37]

I had my surgery on 3/12/19. I watched my insurance carefully because I'm slightly obsessive about numbers. I had called my insurance several times prior to surgery and was told once I met my out of pocket I was fully covered. Out of pocket was met in January. April I start getting bills. I call the insurance company who keeps patching me through to a company called accolade who says I am fully covered and they don't know why the drs office is saying I owe coinsurance. They will send a note to the insurance company. I have called the drs offices and the insurance company and accolade weekly since April about these bills and started making $10-20 payments so I don't get sent to collection. I just get a call today from Accolade who tells me it's not medically necessary and I owe 30%. I said that is not what I was told the numerous times I called. So they sent me to the insurance company to file an appeal. They are going to pull transcripts of my phone calls and hopefully they will pay the balance of the bill. I owe over $7000 for a surgery that I had because I was told it was 100% covered. And the $7000 is for OUTPATIENT. I work two jobs and am a single mother. I don't have $7000. Anyone have any experience with this?

[vovo2013 35]

2 hours ago, DelawareWoman said:

I had my surgery on 3/12/19. I watched my insurance carefully because I'm slightly obsessive about numbers. I had called my insurance several times prior to surgery and was told once I met my out of pocket I was fully covered. Out of pocket was met in January. April I start getting bills. I call the insurance company who keeps patching me through to a company called accolade who says I am fully covered and they don't know why the drs office is saying I owe coinsurance. They will send a note to the insurance company. I have called the drs offices and the insurance company and accolade weekly since April about these bills and started making $10-20 payments so I don't get sent to collection. I just get a call today from Accolade who tells me it's not medically necessary and I owe 30%. I said that is not what I was told the numerous times I called. So they sent me to the insurance company to file an appeal. They are going to pull transcripts of my phone calls and hopefully they will pay the balance of the bill. I owe over $7000 for a surgery that I had because I was told it was 100% covered. And the $7000 is for OUTPATIENT. I work two jobs and am a single mother. I don't have $7000. Anyone have any experience with this?

Who was your insurance company? I am in the same bubble and am scared to get bills in the mail.

[DelawareWoman 37]

Independence blue cross blue shield.

[vovo2013 35]

oh I have Cigna

[GradyCat 3,697]

Oh no! What a horrible situation for you to be in. Did they ever give you an approval code number or anything? When my insurance approved me before surgery, they sent me an electronic message in their online portal and texted me with the approval code that I could use for verification.

[DelawareWoman 37]

Nope. When I showed up at surgery I was even told I owe nothing. Everyone told me I was covered. Insurance. Accolade. Drs. Then I started getting bills a month later.

[DelawareWoman 37]

I'm still in the appeals process. I've called my appeals person twice and yet to get a call back. I'm making very small payments on the bills so they dont go to collections while the appeal is taking place. I was told by one person it was approved and by another that it is still under investigation so still no answers. They have until the 16th to make a decision I am told.