Question:
I need some help, please??

I have cigna hmo... I was 100 percent covered. Yesterday I get a piece of mail from cigna stating they will not pay for the surgical assistant.. and that bill is 1300!! Now, I don't recall my surgeon stating that I was going to be billed for this... I didn't authorize any "extras".. I don't feel like I should have to pay this.. has anyone else had this happen...if so... how did you handle it? Thanks! Chris    — chris S. (posted on November 15, 2003)

November 14, 2003
Most times when the surgical assistant is denied its an error, call your insurance company and ask why they denied it. Due to limitation in the computer systems, all they see it that another surgeon billed for the same surgery on the same day, so its denied for that reason. Most likely it was either billed incorrectly, or denied incorrectly.
   — RebeccaP

November 14, 2003
if you will do a search in the library, you will find that most of the insurance companies do not pay for the assistant fee. mine is UHC and my bill for that part was 1200. When i questioned them, I was told that they do not pay this part. There are many different UHC polocies and this was what my type said. Thank Goodness, I also have medicare and they did pay some of it and the rest was wrote off as a medicare discount.
   — Delores S.

November 15, 2003
Have your doctor appeal that. It was his decision to have one and it would have to be medically necessary and he is the one who needs to explain this.
   — ZZ S.

November 15, 2003
I remember being told to ask my insurance co. if they covered an assistant during the surgery. They did. However, your Dr. can not do this surgery without an assistant. you might try arguing that with your insurance co. If they won't budge, I am sure that they may take payments of some kind to pay it off. Remember that this surgery is around $25,000, so if you ahve to pay $1,500, you should consider yourself lucky to the dozens of people who have to self pay 100%.
   — Michele B.

November 15, 2003
What reason did they give for denying it? They have to give you a reason. Insurance companies usually only deny an assistant surgeon (if it is a medical dr and not a physician's assistant or nurse) for minor procedures that don't require an assistant, not for major surgery like WLS. Sometimes a dr will use a nurse because it is cheaper than another surgeon, and if that's the reason it's not covered, you may have a problem. But anyway, find out the reason and appeal, appeal, appeal. And get your dr involved. As to why your dr didn't advise you there would be an asst surgeon, he probably assumed you would know that it would be necessary.
   — lharbison

November 15, 2003
Chris, I received a denial from my insurance that they would not pay the anthesiaologist because it was not covered and not approved. After I called my insurance they told me it was covered and the anthesiaologist had filed the claim incorrectly. That was why they rejected it. I called the anthesiaologist and told them they needed to refile CORRECTLY. Sure enough, the insurance paid them.
   — jcooper

November 15, 2003
My insurance didn't pay for the assistant surgeon because he wasn't a contracted provider with the insurance company. I didn't find this out until after the surgery.
   — Cosmo K.