Background
I recently discovered some news regarding my health that requires a serious surgical procedure. I was devastated at first, but after being referred to a specialist and hearing about the procedure I was reassured. Because it was found early, my age, all that, it’s not as bad as I initially thought. Good to hear, surgery scheduled that week.
A few days later doctor said they had to reschedule as they’re waiting for the insurance to approve it. Rescheduled for the following week.
I’m getting ready to have the surgery this week and my doctor’s office calls me and says it’s been cancelled because my insurance still hasn’t approved it.
I called my insurance provider—which is through my employer, I’m a union worker—and they tell me that my surgery hasn’t been approved because they just need to ask my surgeon “a couple questions” and that they’ve been trying to call my doctor’s office but that they haven’t been able to get through.
I called the surgeon’s office and they tell me that they haven’t received any calls from my health insurance provider in regards to me or my surgery.
I called back my insurance provider back and tell them that the doctor’s office hasn’t received any calls from them. They say that they have called but haven’t gotten through, and not only that, but that it has to be a face-time call because they just need to ask the doctor “a couple questions.” I say, fine, and end the call.
I’m planning on calling the doctor’s office tomorrow, once more, to see what’s going on. However, at this point, I believe that my insurance provider is giving me the run around. “We haven’t been able to get into contact with your doctor and we just need to ask him a couple questions.” This doesn’t make any sense because 1) my doctor’s office was explicit in letting me know that my insurance provider has NEVER contacted them in anyway since my surgery was first scheduled. Why would the doctor’s office lie? 2) My insurance provider could easily have left a voicemail if supposedly every time they called no one ever answered. And in addition, they could have sent an email as well. I have a life-threatening medical emergency and require surgery. It’s 2021, not 1971. There’s no plausible explanation that my provider couldn’t make contact in some way with the doctor.
Unfortunately, I think it comes down to my provider not wanting to pay for this very expensive surgery by a highly-rated specialist.
My Question
Please, can anyone offer me any advice on what I should do? If my doctor and my health provider do speak to each other via “face-time,” there’s a possibility that the provider will end up denying my claim. What then? And in the mean time, what should I ask my doctor when I speak to him tomorrow. And what should specifically should I be asking my provider? I made the mistake of not asking for details, like, “what exactly are these ‘couple’ questions that you need to ask my doctor?” Is my provider obligated to tell me, or can they claim it’s confidential and only between them and the doctor? Is it possible that they’re going to insist I see someone “cheaper,” someone not highly-rated? What if my claim gets denied outright, then what?
Any help is greatly appreciated.
submitted by /u/ShaunLevi1995
[link] [comments]
Background I recently discovered some news regarding my health that requires a serious surgical procedure. I was devastated at first, but after being referred to a specialist and hearing about the procedure I was reassured. Because it was found early, my age, all that, it’s not as bad as I initially thought. Good to hear, surgery scheduled that week. A few days later doctor said they had to reschedule as they’re waiting for the insurance to approve it. Rescheduled for the following week. I’m getting ready to have the surgery this week and my doctor’s office calls me and says it’s been cancelled because my insurance still hasn’t approved it. I called my insurance provider—which is through my employer, I’m a union worker—and they tell me that my surgery hasn’t been approved because they just need to ask my surgeon “a couple questions” and that they’ve been trying to call my doctor’s office but that they haven’t been able to get through. I called the surgeon’s office and they tell me that they haven’t received any calls from my health insurance provider in regards to me or my surgery. I called back my insurance provider back and tell them that the doctor’s office hasn’t received any calls from them. They say that they have called but haven’t gotten through, and not only that, but that it has to be a face-time call because they just need to ask the doctor “a couple questions.” I say, fine, and end the call. I’m planning on calling the doctor’s office tomorrow, once more, to see what’s going on. However, at this point, I believe that my insurance provider is giving me the run around. “We haven’t been able to get into contact with your doctor and we just need to ask him a couple questions.” This doesn’t make any sense because 1) my doctor’s office was explicit in letting me know that my insurance provider has NEVER contacted them in anyway since my surgery was first scheduled. Why would the doctor’s office lie? 2) My insurance provider could easily have left a voicemail if supposedly every time they called no one ever answered. And in addition, they could have sent an email as well. I have a life-threatening medical emergency and require surgery. It’s 2021, not 1971. There’s no plausible explanation that my provider couldn’t make contact in some way with the doctor. Unfortunately, I think it comes down to my provider not wanting to pay for this very expensive surgery by a highly-rated specialist. My Question Please, can anyone offer me any advice on what I should do? If my doctor and my health provider do speak to each other via “face-time,” there’s a possibility that the provider will end up denying my claim. What then? And in the mean time, what should I ask my doctor when I speak to him tomorrow. And what should specifically should I be asking my provider? I made the mistake of not asking for details, like, “what exactly are these ‘couple’ questions that you need to ask my doctor?” Is my provider obligated to tell me, or can they claim it’s confidential and only between them and the doctor? Is it possible that they’re going to insist I see someone “cheaper,” someone not highly-rated? What if my claim gets denied outright, then what? Any help is greatly appreciated.
submitted by /u/ShaunLevi1995 [link] [comments]Read Morer/HealthInsurance