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 Posted: Sat Jan 16, 2010 3:44 pm Post subject: Insurance wont pay for pre approved surgery |
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It took 6 months of monthly doctor diet supervised visits as ordered by BCBS, that I paid totally for, BCBS refused, After the results BCBS approved me for lap band, approval sent to Doctor in Dec2008. Surgery scheduled for Feb 3rd.
In Jan 2009 I was put into a new building at work was exposed to high levels of formaldahyde that made me very sick.
My lap band surgery was Feb 3 2009, and notification and preapproval had been given to the doctors office the prior december. I never returned to work after being sick, I resigned May 27th, I had the LB surgery and for the last year BCBS denies payment. Do I have recourse. The finally sent me a letter that states my HCA fund is empty. Well yeah, no work, no deductions. Is there anything I can do, I guess I am liable for this $16000, however the letter states I owe the provider $0.00 How can that be.Thank you so much |
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rjanco
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Joined: 16 Jan 2010
Posts: 3
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| Posted: Sun Jan 17, 2010 1:11 am Post subject: |
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By provider you are referring to the insurance company?
You still have a 16k dollar bill from the hospital?
They may have refused it because when they received the information from the hospitals billing department you had resigned. So they assumed incorrectly that you were not covered. What is there reason for denying the claim? |
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BNTRS
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Joined: 05 Nov 2009
Posts: 824
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| Posted: Sun Jan 17, 2010 7:50 pm Post subject: |
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The BCBS letter dated Jan 11,2010 states:
The claim for this patient was reviewed based on additional information rec'd. We have completed an adjustment, and have determined that an additional payment is not available.
Amount applied from your HCA
Remaining balance in the HCA Account $0.00
*Your total responsibilty to the provider of services is $0.00*
This total includes any amount you have previously paid your provider for these services
------------------------------------------------------------
Yes, I have a bill with balance as it has always been an nothing ever paid on it for $16655.63
The surgery was Feb 2009 I recd my first statement from the hospital March 2009. When BCBS was billed as well.They have been billed monthly and I have called them monthly reminding them preapproved and what is the problem. They were stating they couldn't pay because it was coded wrong. I spoke with the hospital and doctors office as well and they had spoke with BCBS as well about incorrect coding, it is my opinion they were using that as an excuse. I have called BCBS religiously every month, for 8 months with them telling me about the coding wrong, Then all of a sudden I rec'd the above letter from them.
(I was on the books for this top fortune 500 company until May 2009
I was recv'ing short term disability then it stopped in April. I resigned in May 2009 and rec'd unemployment)
Thanks again for your help[/quote] |
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rjanco
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Joined: 16 Jan 2010
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| Posted: Sun Jan 17, 2010 9:22 pm Post subject: |
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There doesn't appear to be a problem. It's an issue between the doctor and BCBS. BCBS says that you owe $0.
What kind of recourse do you need/want? BCBS isn't saying that you have to pay and nobody else is requesting payment from you. You don't owe anything.
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Guest 1
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| Posted: Mon Jan 18, 2010 10:01 am Post subject: |
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Guest1 do you have legitimate experience with this? I tend to doubt it from your response.
I am curious as to why you think this is an issue between the doctor and the hospital. The doctor does not owe the hospital over $16, 000 I do!
What do I then do, Ignore this problem of being billed monthly from the hospital? Appears to me I owe a significant hospital bill
Please some one with experience and sound advice please give me a heads up on where I stand in this mess.
Thanks! |
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rjanco
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| Posted: Mon Jan 18, 2010 5:31 pm Post subject: |
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Incorrect coding happens all of the time. You need to keep doing the leg/phone work. You need to find out what procedure code was approved and which code was billed.
EOB's can be confusing, but believe me the provider is going to want to be paid. This will go to collections. Keep contacting the billing department of the provider to get information on what procedure (should be a 5 digit code) was approved. Find out what was billed. You should have received an EOB showing what code was billed....some times the codes are not on the EOBs.
What it comes down to is lets say you were approved for 50134 but they billed it as a 50136 (not correct numbers and used for example only). BCBS is not going to be able to cover the service since that was not what was pre-approved.
Keep on both to get it worked out and keep involved. This means more then a reminder on your part more then "once a month" when you get a bill.
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Dasfuk
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