Help!

My gastroenterologist's office got preauthorization from my health insurance, CareFirst BlueChoice, for a surgical procedure using, "a blind code." Not surprisingly, Carefirst has denyied the claim. Both hospital and doctor have resubmitted under the correct code but I still fear for a denial.

I reached out to CareFirst and was unable to obtain any help beside a repition of the reason for the denial.

The doctor's office, who acknowledges (verbally) they provided the hospital with the initial, "blind," code, graciously states they will write off their portion of the bill. The hospital has not said as much. The directior of billing for the hospital has made comments that would lead me to believe they would not do so dispite the docto'r's office email requesting that they do.

What should I do? While I understand I am financially, "responsible," dosn't the doctor's office have some liability for providing the wrong code and for actually telling me they had recieved all necessary preauthorizations when i tried to confirm prior to undergoing the procedure, not telling me the procedure had been preauthorized using a dummy code and the risks.

To complicate matters… First, the reason for denial is, "Experimental procedure or exploratory." The doctors office states, after some confusion on their part, that the procedure had been considered experimental up until the prior month. This technically would mean that when i underwent the procedure it was an accepted procedure, not considerd, "experimental," but its status had only just shifted. …Thus the presumed need to use a blind code. Second, my family moves to Japan in several weeks for three-years for my wife's employment which seriously complicates the logistics of a protracted campaign.

submitted by /u/rhizome2016
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