Insurance reimbursement help

Hello Vicki or Gary,  (Or anyone who may be able to help) I had WLS on May 9, 2007 and was a self-pay, even though I did send in for pre-authorization from my insurance company and they did say over the phone that my surgery was found medically necessary.  I went ahead and had my surgery and was told I could apply for a refund. Well I am still working on getting them to reimburse me. I finally got one person I am communicating with to tell me exactly what is needed and what the hold u******ce they did say that I was covered and my surgery was medically necessary. They have all my PCP info, notes, diet history, surgeons notes, and on and on.  The insurance is asking the Hospital, where I had my surgery, to provide them with an itemized bill with the CPT-Codes(revenue codes) that insurances need in order to pay out claims.  They said this is my only hold-up.   However, my problem is that since I already paid for the procedure, the hospital will not issue an itemized bill to me with the pricing codes the insurance needs, because they only list CPT-codes on UMB forms, for the insurance company, and I already paid them.  Confusing I know!  But this is my dilemma.   I need an itemized bill with CPT codes to forward to the insurance, but the hospital claims they are not permitted to provide them to me, since the bill is already paid. IS this correct?   Is there some way I can get an itemized bill with the revenue codes?   They hospital claims that I don't have a right to apply for reimbursement from my insurance since they gave a special all inclusive price for this particular WLS.  I am having trouble believing this.  No matter what price I paid, if my insurance said they will recoup my cost, then the hospital should provide me with the codes for services rendered.   This has been going on for 10 months.  Any help or advise you can supply is welcomed.   Thanks in advance, MrsA

I'm curious why you were a self pay if you were given pre-approval ?

Its a verrrrrrrry long story, and I believe a bit of error on the part of the insurance company, but of course, they will never admit it.

I ask because I am a medical biller, but certainly don't proclaim to be an "insurance guru", and deal with alot of carriers network and non on a daily basis.  Something to think about: In my field if my company is contracted with a patient's insurance carrier it is illegal for us to provide a service, ask the patient to pay and never file nor intend to file on their behalf. We are obligated.   I understand it's a long story but you've left alot out for a reason. There are laws in place to protect consumers against things like this.  The insurance commission could do something about it. Have you thought about contacting them? 

Something about this is extremely fishy.   Lots of people have 2 insurance companies, and most of the time what is not covered by one (co-pays, etc) will be picked up by the other one.  That is similar to what you describe.  Although I agree with the post above, why would you self pay when you had insurance coverage?  That makes no sense to me.  I used to work for Blue Cross/ Blue Shield, and I'm sorry, but it just does not happen that a hospital in the United States would refuse to provide an itemized bill with the codes, particularly if the request is coming directly from an insurance company.   Even if you wanted it for your own records, the hospital would be obligated to provide the information.   Something else is holding this up, it is not the hospital's refusal to tell you how much they charged.