Know your post-op insurance coverage

[notmyname 593]

My insurance (like many ) covers 90 days of post-op follow-ups after surgery. The only reason I know this is that I've had surgery before and my ortho doc's office told me. So, my sleeve surgeon's office has twice tried to charge me for visits because they're miscoding them. If I didn't know better, they'd just be making me pay extra. I also had to get on them about charging me more for my surgery than my insurance allows. So, it's important to know your coverage and keep your doc's office honest!

[🅺🅸🅼🅼🅸🅴🅺 296]

How did you end up finding out that they were trying to charge too much for your surgery?

[notmyname 593]

14 minutes ago, Kimmie K said:

How did you end up finding out that they were trying to charge too much for your surgery?

It was really the hospital stay. My insurance is fairly clear that if its a center for excellence, its $X and $Y if not. When I got the bill, they had charged me $Y. Unfortunately, I didn't think about it when I paid it, so I paid the extra money and now have to figure out how to get a refund. Good stuff.

[🅺🅸🅼🅼🅸🅴🅺 296]

Just now, notmyname said:

It was really the hospital stay. My insurance is fairly clear that if its a center for excellence, its $X and $Y if not. When I got the bill, they had charged me $Y. Unfortunately, I didn't think about it when I paid it, so I paid the extra money and now have to figure out how to get a refund. Good stuff.

Ahhh sounds like you have Blue Cross or something. I have Anthem Blue Cross and they require the BC Center of Excellence junk too. So your surgery was performed in the right place and your doctor just charged wrong? That's messed up.

[Orchids&Dragons 9,047]

Cigna requires a Center of Excellence, as well.

[notmyname 593]

Yep. Blue Cross was really quick to issue me a correct EOB, but getting the hospital to fix it is proving harder.

AT least at the doc's office for visits, I just tell them I'm still covered and I'm not paying the copay, so I dont have to try to get money back from them

[🅺🅸🅼🅼🅸🅴🅺 296]

5 minutes ago, Orchids&Dragons said:

Cigna requires a Center of Excellence, as well.

Interesting!

[🅺🅸🅼🅼🅸🅴🅺 296]

6 minutes ago, notmyname said:

Yep. Blue Cross was really quick to issue me a correct EOB, but getting the hospital to fix it is proving harder.

AT least at the doc's office for visits, I just tell them I'm still covered and I'm not paying the copay, so I dont have to try to get money back from them

Geez I'm sure it'll work itself out. You can't be the only person to have to go through this crap.

[notmyname 593]

Update - amazingly, it only took one email to get the hospital to acknowledge the problem and say they'd issue a refund. I am SUPER surprised. A teeny bit irritated that I had to catch it, contact insurance and contact the hospital to get it done, but it could have been SO much harder.

[Starry*Night 148]

1 hour ago, notmyname said:

Update - amazingly, it only took one email to get the hospital to acknowledge the problem and say they'd issue a refund. I am SUPER surprised. A teeny bit irritated that I had to catch it, contact insurance and contact the hospital to get it done, but it could have been SO much harder.

At least you caught it, great job on being diligent!