I had surgery November 4th: outpatient procedure to rule out endometriosis. I had been suffering for a while, we went the conservative route first with meds, but no response and the only option was a diagnostic laparoscopy (which is standard of care). The surgeon had her billing and scheduling department handle everything with my insurance and scheduling the procedure. I work for a hospital system and we are only covered for our systems hospitals which is where I had it done. The surgeon (my OBGYN) is part of a separate clinic group with privileges/contract to the hospital (the hospital I work at by the way).
I had gotten an EOB that showed even though I met my OOP max I may owe a small co insurance for a provider, only $140. No big deal. Today I receive a letter that was dated 12/27/21 saying:
We are sending you this letter because a claim for a healthcare service you had was denied. The claim was denied because the service did not have a prior authorization, which was needed.
If your provider contacts us within 60 days, we can review the claim for retroactive prior authorization. If approved, we can reprocess the claim according to your plan benefits. If we do not hear from your provider within 60 days, the claim will remain denied, and you may receive a bill from your provider for the charges.
The claim says: Provider name “the hospital I had the surgery at” and the charge is “10,190.00”
Of course I get this before a weekend and a holiday. I messaged my doctor ASAP and I can’t call my insurance until Monday. I have so many questions: primarily how likely will I have to owe $10k? I don’t have this, I was told this was all approved and covered and would have never gone through with it had I thought it would cost me $10k. I’m concerned there was an issue since the doctor was a separate clinic group from the hospital system. I had fully vetted everyone to make sure they were under my plan so I wouldn’t get a surprise bill.
submitted by /u/stinkspiritt
[link] [comments]I had surgery November 4th: outpatient procedure to rule out endometriosis. I had been suffering for a while, we went the conservative route first with meds, but no response and the only option was a diagnostic laparoscopy (which is standard of care). The surgeon had her billing and scheduling department handle everything with my insurance and scheduling the procedure. I work for a hospital system and we are only covered for our systems hospitals which is where I had it done. The surgeon (my OBGYN) is part of a separate clinic group with privileges/contract to the hospital (the hospital I work at by the way). I had gotten an EOB that showed even though I met my OOP max I may owe a small co insurance for a provider, only $140. No big deal. Today I receive a letter that was dated 12/27/21 saying: We are sending you this letter because a claim for a healthcare service you had was denied. The claim was denied because the service did not have a prior authorization, which was needed. If your provider contacts us within 60 days, we can review the claim for retroactive prior authorization. If approved, we can reprocess the claim according to your plan benefits. If we do not hear from your provider within 60 days, the claim will remain denied, and you may receive a bill from your provider for the charges. The claim says: Provider name “the hospital I had the surgery at” and the charge is “10,190.00” Of course I get this before a weekend and a holiday. I messaged my doctor ASAP and I can’t call my insurance until Monday. I have so many questions: primarily how likely will I have to owe $10k? I don’t have this, I was told this was all approved and covered and would have never gone through with it had I thought it would cost me $10k. I’m concerned there was an issue since the doctor was a separate clinic group from the hospital system. I had fully vetted everyone to make sure they were under my plan so I wouldn’t get a surprise bill. submitted by /u/stinkspiritt [link] [comments]Read Morer/HealthInsurance