Insurance scare!!!!

[Dave01 0]

Today, one month after having my surgery, I get a call from the billing dept at the hospital. My insurance company has denied my claim!!!!!!

Man, my heart skipped more than a few beats.

I told the lady in billing that I had a copy of the approval number, checked on thier website and all was in order. Seems someone at AETNA didnt have his head screwed on staight. One call back to AETNA from the billing dept and all was good. Man, I was looking at 33000 worth of bills that I didnt plan on. What a day. If I drank, I would have had a few....Dave

[StrawberryGrl 0]

Yikes!! That is SCARY!! Good think you read your paperwork!

[Gean 0]

was this aetna ppo??

[Alexandra 55]

I am always telling people not to panic if they get something unexpected from their insurer or their medical provider. I swear, more than 50% of the time it seems claims are denied for some technical or inaccurate reason. Patients have to be more alert than ever to KNOW what benefits they are entitled to so they can keep their cool when a denial comes through.

Paying a bill that you didn't think you should be responsible for is the LAST thing to do. Get help if you don't understand something; call the carrier first and find out why they processed the claim as they did. Most of the time it's just a mistake on their part and one call will fix it up.

Good on you, and congratulations!

[Dave01 0]

Yep, AETNA PPO

My least favorite people in the world...LOL

All is good now and I am happy

[calunda 1]

I hope that if that happens to me next month that they find a glitch and not make me pay either!

[calunda 1]

I called medicare yesterday and found out that the reason for me paying a large copay is because they have no proof that my bmi isn't 35 or more and there is no proof that I have any physical ailments that I would have that proves that I am needy.

I sent Harper hospital copies of all of my presurgery medical papers and my letter from my physician states that I have sleep apnea, elevated sugar levels, osteoarthritis, hypertension and a bmi of 42.

I have the original doctor's note and all of the other tests. I.E. Cardio (stress test, pulmonary test, physician's letter and psychologist's letter).

After giving Harper hospital a new copy of my physician's letter, what should I do to impress upon those people to tell medicare to change my decision? As of yet, medicare hasn't been charged as I have not had the surgery.

[Dave01 0]

My primary doctor was callng the insurance company daily with information and anything else needed. I would have to say that without his help, it would have never been approved, even though I had all my paperwork in order.

[phyllser 3]

I called medicare yesterday and found out that the reason for me paying a large copay is because they have no proof that my bmi isn't 35 or more and there is no proof that I have any physical ailments that I would have that proves that I am needy.

I sent Harper hospital copies of all of my presurgery medical papers and my letter from my physician states that I have sleep apnea, elevated sugar levels, osteoarthritis, hypertension and a bmi of 42.

I have the original doctor's note and all of the other tests. I.E. Cardio (stress test, pulmonary test, physician's letter and psychologist's letter).

After giving Harper hospital a new copy of my physician's letter, what should I do to impress upon those people to tell medicare to change my decision? As of yet, medicare hasn't been charged as I have not had the surgery.

One thing you should get clarified is whether or not Medicare requires an overnight stay. They have paid on all of my bills except for my $17K hospital bill!! I read on one of these threads that someone had their claim denied by Medicare because they went home the day of surgery so I'm wondering if this is why mine wasn't paid. I trusted my doctor's office to do all the interfacing with Medicare and now I may end up paying for that mistake, LITERALLY!!