explantion of benefits

yesterday in the mail i got form perferred one.  explanation of benefits.  well it looks like i get to pay  the 49,000  for my surgery.  I had gotten pre-approved.  anyone else had this problem and what did u do.  i have no idea on what to do.  it would take a life time to pay that off.   I called the doc's  billing chick in hopes she can help. 

 

Something must be wrong.  I can't imagine any surgeon operating without an approval code for them to bill.  I know that my dr's office required that before doing anything.  I am sure it is a technicality.

we did get a approval code.  it just now they dont wanna pay for it. i guess

Don't spend a minute worrying about it.  The EOB from your insurance company likely says something else that you aren't seeing.  I've worked in medical billing for 15 years.  You can get a denial if a code is missing.  If it gets sent to the insurance company with the wrong ID number.  There are 10's of thousands of reasons you can get a denial.  Unless you get a bill from the clinic, don't worry.  Most often it is the clinic's lack of getting information to the correct payer.  And it also depends on which Preferred One plan you have.  Some are administered through other third party companies, such as Cigna, Fortis, Mail Handlers, etc.

If you'd feel better about it and wish to, I could certainly take a look at it and explain it in human terms.  Feel free to PM me for my email address or if you can fax it to me, etc.  I can read those very easily.

And I guess that goes to anyone else.  I'm very well rehearsed in understanding insurance and appeals, etc.  Always feel free to ask if you have questions.  I try and respond to these sorts of questions as I come across them.



Kelly

thank you,  i faxed it to my dr's billing chick in hopes she can get to the bottom of it.  i just frealing out cause that is alot of freakin money. 

Do not panic!  All and EOB (explanation of benefits) is, is a statement of the services you recieved. and it shows how much was charged, and how much the insurance plan agrees to pay.  It will always show that you owe money.  But, it is not a bill!  It just explains how much your surgeon has agreed to accept from your insurance company for the services listed.  You are covered for everything that is listed.  There may be a few odd charges that you will be billed for later, but no, I'm almost positve you are not responsible for that amount.  I work in the health care industry, and deal with this question on a regular basis, so I'm not taling out of my ass.  wait and see.  Don't panic!

I have preferred one and I wouldn't panic either.  I don't always understand my insurance stuff but I didn't pay anything for my surgery....call the insurance company.