Question:
Has anyone had problems with insurance coverage AFTER surgery?
I had my surgery 4 months ago and was told at my pre-op visit that my out-of-pocket fee would only be $2,500. They said my insurance coveres 90%. Now I'm getting bills for $26,000. I would have never had the surgery if I knew this before hand. Now is a fine time to find out. I don't think this is fair at all! BTC said I need to appeal it. I really need help with a letter. There's no way I can afford this! Has this happened to anyone else? If anyone has any advice or could help me please e-mail me. ([email protected])Thank you so much! P.S. Regardless of this bill, I'm so happy I had this surgery. I'm down 110lbs so far and living life! :) — Jenny S. (posted on July 22, 2003)
July 22, 2003
Have you checked to see if it was an error on the billers part? I once was
charged with an ultrasound because the doctors office put in the wrong code
for the procedure and because there was no referral to go with it, the
insurance company charged me. I had to go back to the doctors office and
say, 'excuse me, but I thought I was covered for this and yadda, yadda,
yadda'. I admit, I freaked out when I had gotten the bill, but take a deep
breath and call the biller and tell them you what you were told and go from
there. :) Hope this helps.
Cathy
— jenlaur1
July 22, 2003
Don't pay it. If they have the approval letter from the insurance and now
the insurance is refusing to pay...then it's BTC's responsibility to go
after your insurance. This is a contract dispute between your insurance
and BTC.
I would tell BTC that you will not pay ANYTHING until THEY settle with the
insurance company. What can they do? You already had the surgery and if
worse comes to worse you can alway find another surgeon for after care.
— SJP
July 22, 2003
Sorry, but I disagree with the previous poster who said not to pay and if
worse comes to worse you could find a different doctor for aftercare.
That's all fine & dandy except what do you do when your home has a lien
put on it or your (or your spouse's) paycheck starts getting garnished.
Ignoring it won't make the problem go away. Definitely contact the billing
department and discuss it with someone who UNDERSTANDS their job and isn't
unwilling to help you figure out how to handle this.
I have seen where the hospital or doctor bills a patient for the amount
insurance has been discounted. It isn't right or legal, but it happens.
Whatever you do, do NOT get an attitude with them because they will note on
your file that you are unwilling to work things out. I'm not suggesting
that you take their word as gold or just idly sit by if they get snotty
with you.
Try to calmly work this out and get a mutual understanding of the
situation. It sounds like a billing error, but I don't know anything about
BTC other than the good & bad comments others have said.
Congrats on your weight loss! That is absolutely terrific! Now go out
there with that great attitude and talk to whomever you need to in order to
resolve this. And please...document, document, document....names, dates,
times, conversations!!!
Good luck!
— Diane S.
July 22, 2003
I do not agree that you should just not pay the bill. I work for my
surgeon, and there was a time when we had this problem with a patient who
got an approval and then the claim was denied. It takes alot of fighting,
but there is a possibility that the bill can be paid. But the fighting has
to involve you. Your insurance contrat is a contract between you and your
insurance company. First I would make suier everything was coded
correctly, and take it from there. Good Luck
— Mandybub
July 23, 2003
I am kind of concerned that you took someone's word that your surgery was
covered, as you said "You were told at your first pre-op
visit...." Did you check your insurance handbook before hand to see if
the surgery was covered, or call to make sure? Did you check with your
insurance company yourself to make sure you had approval? I would start
there - call and see if the insurance company has a record of your approval
for the procedure. Perhaps it was just a missed communication from the
place that does the authorization to the place that pays the claims. If
there was no authorization, YOU may have to appeal for payment. The other
poster is right - you can't ignor it and you can't turn it over to BTC to
take care of. Did you get an EOB's (Explanation of Billing) before you got
the bill? I wish you the best of luck in untangling this mess! Email me if
I can be of any help.
— koogy
July 23, 2003
If you know for a fact that you were pre-approved, and you know for a fact
that you have an oop max of 2500.00, and your surgeon was an in net doc,
and the hospital was in network, call and ask your insurance provider why
you are being billed this amount. If that does not give you the answer
that you feel is correct, call your states Department of Insurance. They
will handle it all for you.
— RebeccaP
August 14, 2003
I also had went to BTC and was told everything I had to do in order to have
the surgery. I went through all the tests, and then in april I called them
about scheduling my surgery, and was informed that BCBS will NOT cover
ANYTHING at Bariatric Treatment Centers anymore. I was crushed, until I
found the CORI Centers and Dr. Wood!! They were awesome and I never had to
deal with the insurance at all. In fact, I just got my "bill"
from BCBS and to my amazement, every penny was covered from my initial
consult to the surgery and pain meds...I owe NOTHING!!! But you may have
trouble getting BCBS to pay anything as they will not cover anything to do
with BTC as of April that I know of. And I was also told that BCBS will
not give pre-approval on insurance, it is just up to your doctors to
approve and hope they pay... :)
— TracyInTheZoo
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