A little background: at the beginning of December, I had an upper endoscopy & a colonoscopy, both recommended by my gastroenterologist due to long term problems. Before the procedure, I talked with the doctor’s office about possible fees & nothing was mentioned about needing authorization, etc. for the surgery – just the deductible (which I hadn’t met yet for the year & possibly needing to pay whatever the insurance didn’t cover.) The procedure went on without a problem, etc. etc.
(By the way, this was my first “grown up, deal with the insurance yourself” type of medical procedure, so I thought I could trust what I was being told by the professionals, oof.)
Jump forward to the 24th, & I received a $3,000 bill from the gastroenterologist’s office. I called Anthem Blue Cross Blue Shield today & found out that the claim hasn’t been technically “denied” but they are waiting for more information to be sent from the doctor about the procedure. Once they receive that, they can adjust the claim.
So, well, okay! I called the doctor’s office to make sure they knew the send the needed info. It turns out the billing department had no clue that extra info was needed, so the person I talked to told me that they would contact BCBS then call me back later with any news. A few hours later, I received that call – it turns out that the office was supposed to get pre-authorization before the procedure, which they didn’t. “It is very rare that authorization is needed for this” were their exact words (in my head, I was screaming “but isn’t that your job to check???!!!”) They are submitting a claim to directly to Anthem BCBS, but I have my doubts & am very concerned that this $3k will be completely on my shoulders.
Does anyone have any experience submitting claims to Anthem BCBS? Any ideas on the chances of the claim going through? & any advice on anything I can do? (My panic level is through the roof right now with the idea of having to completely leave everything up to the office that screwed me over in the first place!)
[Quick edit] I’m not sure if this matters, but the surgery facilities and the lab tests from the procedure were covered by the insurance. The $3,000 is completely for the actual upper endoscopy and colonoscopy.
submitted by /u/pikapikushi
[link] [comments]
A little background: at the beginning of December, I had an upper endoscopy & a colonoscopy, both recommended by my gastroenterologist due to long term problems. Before the procedure, I talked with the doctor’s office about possible fees & nothing was mentioned about needing authorization, etc. for the surgery – just the deductible (which I hadn’t met yet for the year & possibly needing to pay whatever the insurance didn’t cover.) The procedure went on without a problem, etc. etc. (By the way, this was my first “grown up, deal with the insurance yourself” type of medical procedure, so I thought I could trust what I was being told by the professionals, oof.) Jump forward to the 24th, & I received a $3,000 bill from the gastroenterologist’s office. I called Anthem Blue Cross Blue Shield today & found out that the claim hasn’t been technically “denied” but they are waiting for more information to be sent from the doctor about the procedure. Once they receive that, they can adjust the claim. So, well, okay! I called the doctor’s office to make sure they knew the send the needed info. It turns out the billing department had no clue that extra info was needed, so the person I talked to told me that they would contact BCBS then call me back later with any news. A few hours later, I received that call – it turns out that the office was supposed to get pre-authorization before the procedure, which they didn’t. “It is very rare that authorization is needed for this” were their exact words (in my head, I was screaming “but isn’t that your job to check???!!!”) They are submitting a claim to directly to Anthem BCBS, but I have my doubts & am very concerned that this $3k will be completely on my shoulders. Does anyone have any experience submitting claims to Anthem BCBS? Any ideas on the chances of the claim going through? & any advice on anything I can do? (My panic level is through the roof right now with the idea of having to completely leave everything up to the office that screwed me over in the first place!) [Quick edit] I’m not sure if this matters, but the surgery facilities and the lab tests from the procedure were covered by the insurance. The $3,000 is completely for the actual upper endoscopy and colonoscopy.
submitted by /u/pikapikushi [link] [comments]Read Morer/HealthInsurance