My wife has a debilitating case of a condition called endometriosis and back in Feburary she had a surgery which we didn't think would be possible because the specialist was out of network and we'd have to pay out of pocket. We have insurance through my wife's company and knowing her issues and whatnot we've always gotten what amounts to the "Platinum coverage". The doctor's office helped my wife fill out the appropriate forms to try to get part or all of the procedure covered by our policy. To our relief the office told us insurance agreed to cover the procedure.
Fast forward to today and my wife received a call about an outstanding balance on her surgery to the tune of $200+K. Naturally she and I are both panicked. She called the insurance company and they claim to have no record of an "Out-of-Network" exception. The Doctor's office referred her to a billing service. My wife is at work (barely functioning) right now so I'm not sure if there is any documentation I can pull but where should we go from here. Insurance mentioned filing an appeal, would that be worth it or unlikely. Is it possible the doctor's office lied about insurance covering the procedure. Not sure what paperwork we have to support any of this but I wanted to come here for some sound advice on how to proceed.
Submitted June 13, 2019 at 03:41PM by tway22300 http://bit.ly/2KHZ3LQ
