Today I received a denial for payment from my insurance company that was pre-approved. I had major surgery for Thoracic Outlet Syndrome in July, 2018. There is only one surgeon for this in my "in" network plan and she's very young so I opted to travel out of state to get this operation. I selected an excellent doctor who was out of network as is the hospital where I had this operation. My surgeon's office got a pre-approval for this operation from my insurance company and I have written documents backing this up. I double checked with my insurance company before surgery and was assured this surgery was approved and I would be left responsible for the $4,500 deductible. Additionally, I received a letter before surgery from my insurance company confirming my out of network coverage.
The denial letter I received today from my insurance company informs me it was not deemed medically necessary surgery and therefore they would not pay the hospital for it. My surgeon would not have operated on me without pre-authorization nor would I allowed it.
We are not wealthy people and have extended family helping with the $4,500 deductible. This 70k bill will bankrupt us.
I will contact my surgeon’s office Monday and do have written records from them confirming the pre-authorization. I have the records necessary to confirm the pre-authorization.
As an aside, my surgeon was paid already by my insurance so I guess the insurance company deemed it was medically necessary for her to operate on me, but not in the hospital?
This begs the question, what is the purpose of getting a pre-authorization if they can "un" pre-authorize it after they get the bill.
Getting this letter sucked and ruined my day.
Does anyone have any other advise out there or how to handle this?
Submitted September 08, 2018 at 07:47PM by Macfac1234 https://ift.tt/2CB37Lo
