TAH surgery denied AFTER surgery was pre-authorized? Really?!?!

Hi!
Has this happened to anyone before??
After jumping through what felt like 100 hoops just to get my scheduled LAVH approved.... Everything was finally authorized and approved two days before surgery. I had 3 extra tests run and my Dr had to do a Dr peer to peer review. Unfortunately due to unexpected endometriosis my laparoscopic surgery had to convert to an open surgery about midway through.
Now my insurance has denied my insurance claim for surgery based on a loop hole of a time criteria that my hospital and Drs office missed failing to inform them about the conversion. My Dr has appealed and sent in all of my records and authorizations and again the appeal was denied. I am horrified at this point what this will mean.
Insurance paid the assistant surgeon and anesthesiologist , which I found interesting but not my Dr (primary surgeon) or the hospital.
Any experience with this??
Thank you!

That just seems crazy. I have to file a paper with my insurance every year that I don't have additional insurance coverage, I've had claims denied due to that form not being filled out but I've never had to deal with what you're going through. Hope it gets worked out. Our emotions after this surgery is bad enough without having to deal with insurance woes.

Indeed! I was told by my Dr's office that there really wasn't anything I could do. They would continue to appeal and that my Dr would have to do another Peer to peer or speak with them. I really hope it resolves as the billed charges are approximately $38,000. I'm also going to write my states Insurance Commissioner.
Thank you for your support!
S

	Quote:
Originally Posted by Shray Hi! Has this happened to anyone before?? After jumping through what felt like 100 hoops just to get my scheduled LAVH approved.... Everything was finally authorized and approved two days before surgery. I had 3 extra tests run and my Dr had to do a Dr peer to peer review. Unfortunately due to unexpected endometriosis my laparoscopic surgery had to convert to an open surgery about midway through. Now my insurance has denied my insurance claim for surgery based on a loop hole of a time criteria that my hospital and Drs office missed failing to inform them about the conversion. My Dr has appealed and sent in all of my records and authorizations and again the appeal was denied. I am horrified at this point what this will mean. Insurance paid the assistant surgeon and anesthesiologist , which I found interesting but not my Dr (primary surgeon) or the hospital. Any experience with this?? Thank you!

So don't get me wrong, I'm definitely not impressed with your insurance. But if your claim is being denied due to lack of timely filing / notification, why would you have to be the one paying it? This sounds like something the hospital would have to fight or write off, as it is (according to the insurance company) their error.

	Quote:
Originally Posted by ShakeItOff So don't get me wrong, I'm definitely not impressed with your insurance. But if your claim is being denied due to lack of timely filing / notification, why would you have to be the one paying it? This sounds like something the hospital would have to fight or write off, as it is (according to the insurance company) their error.

Oh I certainly agree with you! At this point, I haven't been billed, so it's certainly still in limbo. I've only been notified by my Dr (who is also being denied) and a letter from my insurance that the hospitals claim is in the appeal process post denial. But my thought is the same as yours that if it was error made by another party--- I should not be held responsible.
I was told this could take quite a while to sort out.... so I'm just waiting.
Thank you!!
S