Insurance Nightmare

So, I had my RNY surgery on Oct. 1, 2010.  I am very happy with my surgery and my progress so far.  Months after my surgery, I got a call from my insurance.  Apparently they made a huge mistake.  They approved my surgery, even though my policy had just changed to where out-of-network hospitals and doctors were no longer covered on my plan.  They approved the surgery both verbally with NeWeigh Clinic as well as on paper.  Because of their mistake, they've attempted to workout some type of payment agreement with my doctor to pay him only a portion of what it owed, but he wants ALL that's due to him.  So because he wouldn't work out a deal with my insurance, my insurance has decided to not pay anything more and now there is a balance of $22,000 that might go to ME if this issue isn't resolved soon.

The insurance company won't even accept anymore appeals from my doctor's office.  So he called me in, to write an appeal to them myself on his behalf (which the insurance is now reviewing). Now understand this, my health insurance is self-funded, meaning, we (the employees and our owner) fund our own plan and UMR manages that plan.

So, it looks like I will have to sue my insurance if they deny my appeal because I don't want a $22K hospital bill on my credit.  My fear is, that by suing the insurance for their mistake, I will ultimately be suing my job because they are the ones who told the insurance not to pay another dollar.

I've been with my company for 13+ years and don't want this action to jeopardize my employment.

Has something like this happened to anyone else? Any suggestions?

Call a lawyer, it sounds like you are going to need one.

Good Luck.

get a copy of the acceptance letter from your doctor, then check with HR to see if they have a HR person that works with the insurance company. I would think that if the insurance company they are REQUIRED to pay for the surgery. I agree with Heidi, you might have to eventually contact a lawyer. But first try to work with your HR department.

I have all of my documentation and so does my doctor.  UMR even admitted that they made a costly mistake but still doesn't want to finish paying the bill.  I DID apporach our HR Benefits Specialist about it.  She's the one that told me that they've decided not to pay anymore money to my doctor and that they've washed their hands of it.

I'm hoping I won't have to get an attorney but I DEFINITELY WILL IF I HAVE TO.

 You could also try contacting your State's Insurance Department.  You may be able to file a complaint there.  If not, an attorney would be the next step I'd be looking to take.

Good luck.

 If you haven't already, get HR involved to see if there's anything they can do to help.  If not, then a lawyer.  

Lawyer up.  It's their mistake, they admitted it, they need to pay the bill.