Rats! Insurance Issues

RATS!  I received a bill for over $15K, for a second surgeon in my surgery.  I was approved for the surgery by my health insurance (Blue Cross/Blue Shield) - but I guess I didnn't realize that the second surgeon would not be covered.  Im stressed.  I guess my point is, everyone needs to be fully aware of what their insurance will cover.  Simple knowing that you had insurance approval is not enough. 

I'll need to become educated in what to say to the insurance company, to challenge their non payment!

Did you know ahead of time that there would be 2 surgeons? If not I would call my surgeon and ask why that was necessary, also ask when they sent your stuff in for approval did they include two surgeons. If they did , then you have a place to start with your insurance company. Also get the name of your second surgeon and call bcbs and find out if he is usually covered, that could also help you.

Just my thoughts,

Teri-Lynn
POI

I would call your surgeon's office tomorrow and discuss it with them.  In the end you're responsible, yeah, but they should have known the approval the received was for one surgeon.  Did you know a second surgeon would be in there?  What exactly did your approval letter say?  Diid the surgeon's office request approval for two surgeons?

 I have a similar issue with the surgery I had in August for my mysterious abdominal pain.  The primary surgeon was covered, but she utilized her PA when trying to free the intestine from the mesh (from a hernia repair) that it was growing into and from a bunch of adhesions... and the insurance company indicated that the severity/extent of the surgery did not warrant an assistant.  I am appealing it, and sent them a copy of the operative report that indicates how difficult and tedious it was to get the intestine free, but I am not very optimistic.  The second part of my argument -- which they told me not to even bother putting in the appeal, but I did anyway -- was that I was not aware that anyone but the surgeon would be involved (and did not have a choice in the matter) and that if the surgeon had been required to do it alone, it would have taken her significantly longer so HER bill would just have been higher (probably higher than the charge for an assistant), so it actually saved them money.

Based on my original conversation with the people at the insurance company, this issue with using assistants or an additional surgeon for surgeries that the insurance company believes don't require any assistance is relatively common.  

I have to wonder if this is one of the things that insurance used to routinely cover but that they are now are refusing to pay for in an attempt to cut/control costs.
Good luck on your appeal.  My dollar amount is a lot lower than yours, but still significant.

Lora

I had the exact same thing happen to me. I made darn the surgeon that did my surgery was covered on my ins. I was out when they put the assist surg to work. Not my choice who they put there. I flipped out. I do not have 15k period. Call your surgeon. I know they all work things differently. But I was put to ease once I called my surgeon.

Everyone has given you some great advice.  I would also suggest that you speak to your insurance company about getting a retroactive authorization for the 2nd surgeon based upon medical necessity.