Surg. Approved, Now they won't cover Anesthesia

Hi all.

Just wondering if anyone has any advice or hints on how to go about fixing this.

I had my insurance approval for my DS surgery in May.  I had my surgery on July 10th.  Yesterday, I received a statement from my insurance company (Humana HMO) that states that I will end up owing the anesthesiaologist  $3600 because : "This service is not covered under your plan."  WTF??  So they approve surgery, but I'm supposed to have it awake???  

I want to appeal this.  I have NO idea how to even begin the process.  Any help would be appreciated? 

Thanks!

Theresa

i have no advice, but that just seems plain ridiculous!

Ditto the first responder.  Sounds like somebody billed an incorrect code.  I would call the anesthesia billing dept. to ask them about it first just to make sure it wasn't them.  It wouldn't be the first time somebody transposed a number.  After they've confirmed the correct procedure code was billed, then call your insurance company and ask them to explain.  Remember, it's humans keying in this information.  Wilder things have been known to happen because of typos.  When my 2nd son was born, whose name is Brian Patrick, the doctor's fee for performing his circumcision was denied based on "this service is not a covered benefit for females".   The EOB even showed "M" for male child.  To err is human as they say. 

Theresa call the insurance and find out exactly why the service is non covered?  That should be your first start before appealing.   There could have been a problem with the coding from the Dr's office, or incorrect information submitted.   Start there first

I hadn't even considered an incorrect coding!  Thanks for the hints.  I hope to get started on this this week. 

Thanks again!

Theresa

Be aware that BC/BS FEP  this year stopped covering anesthesia if the anesthesioligst (sp?) is not participating.   Most of them are not.  (apparently it pays them very little).

I verified with our hospital AND the surgeon) that the anesthesia was covered as part of the surgical package (we are with a COE).  

Just a thought, as I know this is how it is at our hospital...

Perhaps the anesthesia provider doesn't accept your insurance... and that's why you'd have to pay out of pocket for it.