$2k bill 3yrs after survive date???

Dec 2018 my wife underwent breast cancer surgery. Along the way there were some denied claims that I tracked and was able to appeal and get covered. Looks like one slipped through the cracks from the cosmetic surgeon.

The insurance says the code used was “Cosmetic surgery, not part of an accident” which seems like a confusing way of saying “wrong code.” The insurance said the surgeon did an appeal with the same results… so someone dropped the ball.

I was told I got a letter sent to me saying the claim was denied (the actual claim was only partially denied, the $10k claim was covered but $2k was denied). The medical billing from the provider just billed me two months ago (24mos+ later) which is what alerted me.

The insurance says I’m past the 180 days to appeal after the appeal has been denied.

Do I have any other options besides just pay the bill?

I live in CA, the insurance company is in TX. I’m no longer with that insurance company.

Any help would be really appreciated, $2k is a big deal at the moment.

submitted by /u/ivanlawrence
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Dec 2018 my wife underwent breast cancer surgery. Along the way there were some denied claims that I tracked and was able to appeal and get covered. Looks like one slipped through the cracks from the cosmetic surgeon. The insurance says the code used was “Cosmetic surgery, not part of an accident” which seems like a confusing way of saying “wrong code.” The insurance said the surgeon did an appeal with the same results… so someone dropped the ball. I was told I got a letter sent to me saying the claim was denied (the actual claim was only partially denied, the $10k claim was covered but $2k was denied). The medical billing from the provider just billed me two months ago (24mos+ later) which is what alerted me. The insurance says I’m past the 180 days to appeal after the appeal has been denied. Do I have any other options besides just pay the bill? I live in CA, the insurance company is in TX. I’m no longer with that insurance company. Any help would be really appreciated, $2k is a big deal at the moment.
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