Surgery covered by insurance, complications not?

[Yarnspinner 1]

Has anyone run into this? My insurance covered the surgery and I was approved with no problem. Unfortunately, about a week out I had an infection and then a leak. I was in and out of the hospital 3 more times over 5-6 weeks. The last time I was probably in for a couple weeks straight. I don't really remember because of the meds. I had to have another procedure to put stents in and another to take them out. There was a picc line that the insurance said they would only cover in the hospital while taking nutrition. They paid for a visiting nurse when I was released and used the picc line for antibiotics. They are currently paying for nutritional supplements. My doctor or the hospital got approvals for my stay and procedures each time they needed me to stay longer.

I am so confused. Last week I received 2 letters from my insurance insurance denying 2 big claims, totaling about $65k. I think these claims are mostly related to the stay resulting from the second procedure. I think these bills probably include the second procedure? Anyway, they denied the medical provider's final appeal stating it wasn't under the policy.

The letter states that I can appeal. I called and they said I could write a letter but they wouldn't send me any of the documentation. They said I needed to speak with the medical provider. I called the hospital and they said to call the doctor. I haven't been able to get in touch with them yet.

I don't really know exactly how this isn't covered and I don't really know how to start. Has anyone else encountered this? The last hospital stay was because I couldn't even keep Water down and the insurance company wouldn't allow me to receive 2-3 weeks of nutrition through a picc line without being in the hospital. Neither I, nor anyone in the hospital, thought I could recover without food and water that long. Obviously.... I'm wondering if they found this not medically necessary?

Has anyone had to appeal medical bills afterward for things that you think should be covered? I never thought I would end up with this much to pay. I want to file the appeal but I'm not really sure how to go about it. My insurance company is BCBS OK but I live in another state.

[Debbie Jean 406]

Call the hospital. Every one I have been in requires you to sign a form... among the bezillions you sign on admission... that gives the hospital the right to file appeals on your behalf if the insurance denies the claim.

Since they covered your surgery, this just has to be a mistake... maybe some paperwork they need or a clerical error.

You definitely don't need the extra stress and drama! I'm so sorry to hear you have had complications and hope you will be feeling better and better. Call the folks at the hospital and you just try to relax and heal ????

(((BIG HUGS))

[Yarnspinner 1]

Call the hospital. Every one I have been in requires you to sign a form... among the bezillions you sign on admission... that gives the hospital the right to file appeals on your behalf if the insurance denies the claim.

Since they covered your surgery, this just has to be a mistake... maybe some paperwork they need or a clerical error.

You definitely don't need the extra stress and drama! I'm so sorry to hear you have had complications and hope you will be feeling better and better. Call the folks at the hospital and you just try to relax and heal

(((BIG HUGS))

[Yarnspinner 1]

Thank you for the kind words!

The letter stated it was the final appeal for the medical provider. I'll try calling and escalating though. They have to provide me more info so I can appeal. I can't imagine they wouldn't cover the stents and all that entailed, but they covered the visiting nurse and antibiotics when I was released after all that? It just doesn't make sense.