xp - Post-op insurance frustration

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).

Write a letter and tell them the claim  needs to be paid within 30 days or you will turn it over to the insurance commissioner of your state.  No insurance company wants to be turned over, this is a black mark for them.  Make sure you send if certified with a signature receipt.

I use to file insurance for several doctors office and anytime I had a hard time dealing with an insurance company this is what I did and I would get payment immediately...

That would work if my insurance wasn't self-funded by the company.  When a company has self-funded insurance the states have No authority...it falls under ERISA law and becomes a US Dept. of Labor issue. 

Thanks for the help though...it might help someone else.

After I posted I thought of that.  Was hoping it was not self funded....OK, still write a letter and copy your employer.  Your employer should have a representative that works between your company or the insurance company that will help you.  I had to do this with my husbands insurance company that was self funded.  I was having problems with a claim being paid and I contacted the liaison for help, got it paid immediately...Again, send everything certified with return signature....Good luck

 This stinks!!

I got nothin', but. . . 

. . . PuggyDawn swears by swinging chickens above one's head, though. (Sorry)

ok that post made me laugh.

Man, what a bunch of jerks!! Not only the insurance company, but the doctor's office, what a complete a-hole to lecture you on paying your bill!!!  Isn't this harrasment??? I am so sorry....I hope you get it cleared up soon!!!

First, I'd gently remind your doctors office that you can't get blood out of a turnip and to go ahead and send the damn bill ahead to you if that will allow them to stop harassing you by phone. 

If your insurance is self funded, is there a 3rd party administrator? I was having a problem with our self funded insurance--Cigna preapproved then 3rd party administrator said they may not pay  because of some decision to re-interpret the obesity exclusion (but this was prior to surgery). I did contact Kelley at Obesity Law. She was really helpful and very prepared to take the case should it have come to that but she gave me great feedback in the mean time.

The Dept of Labor did nothing. Really disinterested and give tons of leeway to the insurance company.

I'd be interested in hearing about the 3rd party thing.

Take care,

Denise

You would think a Doctor (who gets 40k for a surgery) would not be hurting that bad for money! That is very unprofessional IMHO, their best advertisement is a happy customer! and that would definately not make for a happy camper!
Good luck getting it squared away.

Hi, I am not totally familiar with your case but, my FIL has had a really difficult time getting  his medical bills paid. He was a postal worker and was in a terrible accident while driving on the job and subsequently had to have one leg amputated. Anyhoo, the Dept. of Labor was involved because while he was on leave, his pay was coming from them, not the USPS. Do you work for the gov.?