So basically I had precancerous cells found in my uterus so my doctor said hysterectomy was necessary. I’d had a surgery prior to this one that went off without any issue, everything was billed properly. Because of that I met my out of pocket max.
I have so far received two claims, one for the doctor which states I owe about 800$. This should be covered as I met my max. It says the dr billed 3000$, $1000 was taken off by the plan discount and then only a thousand was allowed by the plan. Then it says the plan paid 213 and I had to pay 882$. There is a big green check mark next to this claim and it says Approved. I also paid a copay to the dr office prior to surgery so they obviously pulled that number from my insurance company so a conversation had to have happened to get that number.
There is then the second claim for the Anathesiologist. It’s boils down to around 5k and I pay nothing, because I met my out of pocket max. It says 0$ owed, and also has a big approved next to it .
So I chatted into my company to see why they are expecting me to pay 800$ on the dr bill, then he says that the claim is denied because I didn’t get preauthorization. Which is insane because why would my dr office do it for the first surgery and not the second? Initially my surgery was on the 8th of December but then moved it over to the 9th, not sure if that has any bearing.
I have several other claims that I was billed 0$ for prior to the dr bill and the anathesia bill because I had already met my out of pocket max.
I don’t understand how they’re saying they didn’t get pre authorization when anathesia’s bill was fully paid for. And my dr would never have done the surgery without the pre authorization taking place.
I did call my dr office to see if they have the pre authorization forms there and something’s just missing in translation but now I’m freaking out that the hospital bill will be denied and I’m going to be on the line for thousands and thousands of dollars despite having a medically necessary surgery that I waited a month and half for. I’m still in recovery it’s only been 2 weeks and I’m stressing out.
This dr is in network, and so is the hospital I went through, I made sure. It seems like some info must be getting lost here because why would this guy tell me over chat that they never got preauthorization so the claim is denied, but the on my app it says it was approved.