xp - Post-op insurance problems

Has anyone been pre-approved, had the surgery and then had a hard time getting insurance to pay the bill???

I had surgery 9/22  and was pre-approved with United Health Care.  I got a call from my surgeons office this week that they haven't been paid yet (4+ mos) and that I need to do something about it or I will get the bill (over $40,000)!  I call UHC and am told that it has been forwarded to "rapid resolution" and they have to process it.  It will take 10-14 days.  What????  You've had 4 months to process it!!! WTF???

Now I get daily calls from my surgeons office to see what I have done about this.  Thursday the office manager calls and says "please hold for the doctor".  Next thing I know I am getting a "friendly" lecture on needing to take care of this, the accountant is hounding him to get payment, that I will get the bill, etc. etc.  Double WTF!?!?!  I am not stupid, I don't need the doctor telling me what to do and trying to guilt me into something.  I was pleasant enoough on the phone, but I wanted to SCREAM...F*CK U...I am not some stupid child who needs a talking to by a doctor.  I'm a f*cking lawyer and don't need to be treated like a moron! 

So after that I am PISSED!!!  So, I call UHC AGAIN and now threaten filing a complaint with the Dept of Labor.  Suddenly my claim is being sent to a different department - complex claims - and that I will get a call back on Tuesday. 

I ask to speak to supervisors every time and I am told no.

I called the Dept of Labor on Thrusday and filed a phone complaint.  They told me they can't really do anything until UHC denies the claim. 

The kicker...every other bill associated with the surgery was paid months ago....the hospital, the radiologist, the anesthesiologist, labs, etc.  The only unpaid bill is the surgeon.

So...........................................has anyone else experienced this?  Any recommendations?  Advice?  Any and all good juju would sure help!  (Can't hurt).


P.S.  The insurance is self-funded by the company, so it falls under federal ERISA law, not state insurance departments.

Insurance is really good about doing this...The dr office knows this, but they are just doing their job by trying to get the bill paid.  I would just tell the same thing daily... "I have called my insurance company, they are taking care of it...her is their number and name".  If, and I doubt this will happen, but IF the insurance says they didnt approve it, then I would get an attorney, but I bet it will all get taken care of.  I understand your frustration though.

Never take a no from someone who can't give you a yes.  I'd demand to speak to a supervisor.  It is their JOB to try to keep you from speaking to one.  Simply state that while you appreciate their hard work, you need to speak to someone higher up since this is an ongoing issue.  After you demand such about 5 times, they will finally relent and let you talk to one.  Just keep demanding a supervisor.  At that point, I would threaten to get an attorney involved if they dilly dally around on the issue.  They have to pay it. 

Regarding your doctor's office... if they are calling you daily?  Next phone call you get, you need to be firm and frank with them.  Let them know that you ARE doing everything in your power to rectify the situation, and you sympathize that they have a job to get done, but their phone calls have crossed the line into harrassment.  You are only one person and you can't ge****er out of a rock.  If they were unable to get a response out of them in 4 months' time, why do they suddenly demand miraculous results from you?  Also, if your surgeon's office is affiliated with a bigger organization or hospital, find out some names of the top people there.  Next time, you can drop one of their names in the context of conversation:  "Oh, I'm familiar with John Doe.  I have no issue with alerting him as to how unprofessional your office has been with respect to this situation.  It's very unfortunate."

If you insist on being nice, be nasty nice.  Be cold, be blunt, be firm, and assertive.  It's business, not personal.  I know they say you catch more flies with honey, but you can't let people walk all over you, either.

Let us know how it turns out.