Insurance Denied Surgeon charges

[rosepetals 1]

I was sleeved Dec 22nd and have had a pretty good recovery. However, I was checking out my med insurance webpage and saw that my surgeon and asst surgeons charges were denied. I am upset at myself because I trusted my patient coordinator to take care of this. I had a change of surgeons because the surgeon I chose would not be available for surgery, The surgeon is part of my network, but his name is not on the authorization request. The assist surgeon was not part of my network which also resulted in a denial as well. I am looking at a total of close to $15,000 if the billing office is not sucessful in their appeal. I am beyond frustrated. No one thought to contact the insurance to get the ok for either of these two guys for the surgery? The program I entered handles hundreds of surgeries monthly and I cant believe I fell through the cracks this way. I should have been more dilligent in following up with the insurance, This after we paid the hospital the entire deductible owed and now my other bills are being applied to deductible because the hospital bill was submitted after the fact. Insurance says its my issue and I must persue the hospital for a refund.

[MINI-Me 196]

Don't panic ... I'm in the business & this happens all the time. I'm sure your claim was submitted and was auto-denied by the system because not everything matched up. The surgeon's office should be able to contact your insurance company and square things up. For the assistant surgeon, was it a total denial or did they reduce payment? The surgeon's office may be able to help on that as well.

the deductible part should be easier to fix. do you have an EOB showing what you should owe the hospital? If so, take it and your hospital payment receipt to the billing office. They should be able to cut you a refund check right there. If they refuse, then it does become an insurance issue because the hospital is not meeting their contractual obligations with the insurance company to only bill for amount due AFTER insurance pays.

For a while, it's going to be a bit of a mess with all the moving parts, but it will be ok. Just keep good records, copy everything and make sure insurance EOB's match all doctor/hospital bills before paying anyone anything.

[rosepetals 1]

Don't panic ... I'm in the business & this happens all the time. I'm sure your claim was submitted and was auto-denied by the system because not everything matched up. The surgeon's office should be able to contact your insurance company and square things up. For the assistant surgeon, was it a total denial or did they reduce payment? The surgeon's office may be able to help on that as well.

the deductible part should be easier to fix. do you have an EOB showing what you should owe the hospital? If so, take it and your hospital payment receipt to the billing office. They should be able to cut you a refund check right there. If they refuse, then it does become an insurance issue because the hospital is not meeting their contractual obligations with the insurance company to only bill for amount due AFTER insurance pays.

For a while, it's going to be a bit of a mess with all the moving parts, but it will be ok. Just keep good records, copy everything and make sure insurance EOB's match all doctor/hospital bills before paying anyone anything.

Thanks Mini.

I called the dr office and they told me to send them the EOB. I will follow up on Monday and hopefully get this resolved.