BCBS Arkansas

[lvidacovich 372]

I was hoping this would all get resolved and I wouldn't need to post about it but here we are.

My surgeon and her team always had trouble with my insurance. They wouldn't respond to requests and they could never give me an idea of how much it would cost me. I got a pre-approval from insurance before surgery.

After surgery my $130k bill got sent over to insurance and of course they denied it. They said they requested medical records from my provider but that request came through BCBS Oklahoma since I'm out of state from BCBS Arkansas. My provider said that request gets routed through the billing department and that they'd check to make sure they got the request.

It's been a week now and I got the letter with the $130k bill where insurance paid like $500. Every line item has a note saying "Medical records requested and not received" and one line item said "Weight loss procedures not covered" despite getting pre-approval. I'm also $300 short of my OOP max and I paid that a week before my surgery but of course my insurance doesn't show that payment and shows me still under my OOP max so I'm still paying out of pocket for everything.

So at this point I'm incredibly worried. If the hospital doesn't send my records then they have to write it off right? Am I better off not calling them to see if they got the request in the hope that they write it off? If I do get a bill for $130k or so would it be too late to convert to self pay and just pay $10k? Has this happened to anyone else and how did it work out for you?

[AJ Tylo 1,398]

Wow - Ok i went thru this with a heart surgery - Hope this helps - That seems insane in price since i paid 25k cash for both doctor and hospital in Naples Florida which is grossly over priced. The hospital put me down as a outpatient procedure so i capped my limit at 15,000 my bill was 225,000

1. Drive down to the hospital and see the billing department in person, also go to your doctor and get them to send the records. You buy law are also entitled to a copy.

2. Send a letter saying pretty much working on it and the records are coming -

3. The phone is a waste of time, So his email. You need to do it in writting and send delivery confirmation

4. I still could not get anywhere so i took all the parties to court, Hospital and Insurance company. Guess what the judge instructed them to handle this matter ASAP and got me out of it.

[lvidacovich 372]

Good to know AJ! I called both the hospital billing and my insurance company just now. Billing said they sent all the records and insurance says they have gotten about half but they are coming in slowly but surely due to the system they use. Was advised to check back in a week on status. Was advised they will automatically re-review my claim once they have the needed info.

I've already made a request to get my records on a CD so that I have a copy, good idea. Insurance said they can take up to 30 days to review so I guess I won't freak out until they have the info they need and finish their review and then deny parts of the claim.

[catwoman7 10,846]

I had something like this with my plastic surgery. It was not covered by insurance, but I got a bill for $144K about a month after my surgery. I'd actually already paid for the surgery - self-pays generally have to pay BEFORE the surgery, but it was around $20K, not $144K. But still, I shouldn't have been billed AT ALL unless they had to do something unforeseen (which they did not). It took a few months and several phone calls to get this all cleared up. They did stop sending me bills for $144K pretty quickly, but then they started sending me bills for $20K - which is about what I paid, BUT I'D ALREADY PRE-PAID it!!! ARRRGGGGHHHH!!! Luckily, it's over now. I think. (I can't really blame the hospital - their billing is outsourced to some third party. But still...)

[lvidacovich 372]

Quick update - still dealing with this but I've got it down to 1 thing that insurance says they still need - the NDC # for a generic drug I was given - C9399.

Hospital told me they requested it but might not get it back and if so they'll tell the insurance they can't provide it and I won't be charged for it.

I'm gonna give them the week off from my calls since it's Christmas but next Monday I'm hitting everyone up and asking for updates - making sure insurance has everything they need and finding out how long it'll take for them to decide how much they're paying and thus how much I have to pay.

Wish me luck!