what do i do

[tawandabee 0]

So mad right now my insurance company called to tell me that my claim was denied, because the doc did not wait for approval to do the surgery. They want me to file agrievance against the doc. Due 2nd fill on friday and the office did not call me yet:cursing:

[Donnainva 0]

Go to your HR office and ask them where to go with the insurance company.

I waited until I had the "Your surgery is approved" letter from BC/BS in my hand.

[ParrotheadCathy 0]

Honestly don't know. Part of me says this is all the doctor's problem because he should NOT have proceeded with the surgery until he had written evidence that he would be paid. The doctor is pretty much going to look to you to pay the bill now, so a grievance would probably be the first thing to do to try and keep from having to pay him for his error. But do I know if that will work or make a difference? Absolutely not.

[Gregeriffic 0]

you are screwed, either way. but hey a least youll look good going down. :-)

[Cleo's Mom 257]

Did you sign anything in the doctor's office that said you would be responsible for payment if your insurance didn't pay? If so, you need to get a copy of that. If you didn't sign anything to that effect, then I would say that it is a problem between your doctor's office and your insurance company. He acted irresponsibly and unethically to do an elective surgery before it was approved by insurance. He should be reported to the hospital administrators and the state's medical board. If I were you, I would not pay anything. I would exhaust all my options first in fighting it and if no luck, then get a good attorney. Good luck.

[sandi1011 0]

wow that is a hard one!!

i would think that it would the doctors fault if he did not wait for approval.

i know my doctor would not do anything until the approval came thru ( actually 2 days).

i know that is not any advice, but i sure would fight it!

good luck

[scottyd 0]

I would have thought the hospital would have thrown a wrench in the deal before it went down to. Well you got the surgery done so be happy and you should be able to make payments now that it worked out this way.

[Evie71609 0]

Wait for your insurance EOB (Explanation of Benefits) comes in... look to see what the patient responsibility says- it will most likely say NOT PATIENT RESPONSIBILITY at that point if you doctor is a participating provider you will not be obligated to pay (no matter what you signed)

I know this because I run a huge medical practice and we have this happen occasionally.

[tawandabee 0]

Thanks I am waiting for EOB to arrive

[itschoice 0]

Wait for your insurance EOB (Explanation of Benefits) comes in... look to see what the patient responsibility says- it will most likely say NOT PATIENT RESPONSIBILITY at that point if you doctor is a participating provider you will not be obligated to pay (no matter what you signed)

I know this because I run a huge medical practice and we have this happen occasionally.

Let us know what happens. I would be so worried. Are you okay? You have to just take it easy and wait and see what happens. I am so glad that eviebell has some first hand information because I don't know what I would do.

[Kristine73 1]

Also, you may want to check with ins policy. I know mine has something that says if you had an appointment/procedure that was referred to you by your doctor and you went through with the appointment/procedure before you received a denial letter, you can refile it so that you are not harmed, financially. It's basically an after-the-fact appeal.

But, I also agree with eviebell, wait for your EOS.

Good luck

Kristine