I have not yet received any bills for the two issues I'm about to discuss, just the EOBs (Explanation of Benefits). For non-US readers, this is a notice that an insurance company must send the patient whenever the insurance has received a bill. It explains to the patient about the bill: the medical provider, the service rendered to the patient, the charge from the medical provider, how much of that charge will be covered by insurance, and how much the patient can expect to self-pay.
My original surgery date was delayed/changed due to the hospital's COVID-related closure to elective procedures. I therefore ended up having surgery about 6 weeks after my original date. I just received the EOB relating to the hospital's $55,000 charge. The EOB states the charge has been denied due to "preauthorization was not obtained". I went through all the paperwork I've collected since my journey began and found the preauthorization approval notice for the original date of surgery... but it seems I never got a preauthorization approval notice for the new surgery date. Naturally, the surgeon's office has several people whose job it is to get insurance approvals/preauthorizations prior to surgery... I'm worried that the person handling my case dropped the ball...
The second billing issue concerns an EOB that shows I will owe $900 for the nurse anesthetist's bill ($500 deductible plus 50% copay). The anesthesiologist's bill was covered at 100%, but the issue is that his assistant (the nurse anesthetist) apparently doesn't participate with my insurance so I'd be responsible for the high out-of-network charges! Naturally, I as the patient only get to pick my surgeon... I don't get to pick the anesthesiologist or the nurse anesthetist or any of the nurses, for that matter. Again, the team used for my procedure is something that my surgeon's office and the hospital should have put together properly.
I called my surgeon's office a week ago and was transferred to the insurance specialist's voicemail. I've not received a call back. I'll try again tomorrow (Monday) but I'm worried... should I be?
I know a lot of people here have had their surgery dates moved around due to COVID, so this can't be the first time this issue has come up...?
I'd appreciate advice and opinions. Thank you!