I needed to get a surgery (urgent but not an emergency). The provider (orthopedic) is in-network but choose an out-of-network assistant for the surgery.
They did not notify me of this and sounds like they don’t have to in Colorado but there are laws to prevent this starting in 2022 as I understand.
I called my insurance and they told me that the surgeon did not get pre-approval for an assistant so they are not paying.
I received a letter from the medical assistant’s billing company in which they discounted the original bill to closer to what would be allowed if they were in-network. They are asking for me to appeal in which I need to fill out a form. I can also appeal directly with my insurance (cigna high deductible/hsa, out of pocket met for in-network). What I don’t understand is what are the potential outcomes of any appeal and who does this benefit ?
submitted by /u/mtbandrew
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I needed to get a surgery (urgent but not an emergency). The provider (orthopedic) is in-network but choose an out-of-network assistant for the surgery. They did not notify me of this and sounds like they don’t have to in Colorado but there are laws to prevent this starting in 2022 as I understand. I called my insurance and they told me that the surgeon did not get pre-approval for an assistant so they are not paying. I received a letter from the medical assistant’s billing company in which they discounted the original bill to closer to what would be allowed if they were in-network. They are asking for me to appeal in which I need to fill out a form. I can also appeal directly with my insurance (cigna high deductible/hsa, out of pocket met for in-network). What I don’t understand is what are the potential outcomes of any appeal and who does this benefit ?
submitted by /u/mtbandrew [link] [comments]Read Morer/HealthInsurance