stupid doctors office - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

rivi23 · 03-31-2008, 05:27 PM

SO I had my GBS on March 17 and friday at 6pm I get a bill from the surgeon for 7500 saying I did not have prior approval. I flipped my lid, I DID have prior approval. So today I call my insurance company and come to find out that when they filed my pre approval form they put out patient, rather than impatient. WTF? (Pardon my language but at this point I am REALLY upset)

So this nice lady at BCBS tells me what is going on, and that the 22,000 dollar bill from the hospital has been resubmitted, but not sure what is going on with that yet. She told me that I probably do not have anything to worry about, but there may have to be an appeal on the hospital bill. All because of one freaking word. Whoever did my paperwork at the surgeons office, is going to get an earful from me sometime this week. The surgeon's office is going to have to appeal the decision due to this error, and on the phone today she was like I have no idea why this was done like this, we NEVER do this.

SO I am soooo nervous. I may have to get a lawyer, because I would not have had this surgery unless my insurance company was going to cover it. We do not have 30000 to just pay out. I am not sure what is going to happen, I cry all the time, my mind races, I can't sleep, and I have no control over this situation.

I mean technically I guess I did not have prior approval for an in patient procedure, but come on. I never even got a letter, BCBS just sends it to the doctors office. The lady at the insurance told me that I am not liable for the surgeon's office mistake, and they operated on me after reading the letters, without prior approval. BUt...this does not make me feel better. My husband says we will get a lawyer if needed, but why is this happening? I need an advocate, I guess that will be a lawyer if I need one.

Wish me luck,

bridgetgirl · 03-31-2008, 06:50 PM

Do you have a HMO or PPO insurance?

Nyn · 03-31-2008, 07:44 PM

Please, take a deeeeep breath. I have been exactly where you are before, a couple of different times. The most recent example: I had an emergency surgery to save my life a year and a half ago, and later received 3 different, crazy bills from the hospital for differing amounts, each several thousand dollars. I was like, "WTF?!? Did they operate using a scapal made out of solid gold??" Each time I called my insurance ready to scream and yell if they didn't say that they were taking care of it, but each time the rep was like, "There is some mistake, let me resubmit" and each time the mistake was cleared up, and I never paid a dime. In your case, this sounds like an honest mistake that had nothing to do with you. From my experience, insurance companies make lots of mistakes. I honestly believe it will be cleared up, and even if not, it is too early to panic. You JUST had surgery and sometimes these bill things take a couple of months to process/resubmit/whatever it is they do. But I wish you really good luck in straightening this mess out.

mac409 · 03-31-2008, 07:56 PM

Relax, you are not doing yourself any good stressing out over this. I have also had a similar problem and it was taken care of without too much of a hassel. Above all you have to take care of yourself, stressing out will not help the problem it will only make more problems to deal with. Your health is the most important thing to concentrate on right now... Be kool, don't worry be happy as the song goes....

bridgetgirl · 03-31-2008, 08:13 PM

Being in the medical field myself, even with the best of intentions sometimes mistakes can be made. I remember I got a bill for $1500.00 (can remember which office sent it) they said I hadnt paid my out of pocket. I contacted the appropriate people, gathered my reciepts, called the insurance company and sent it to them. Called the facility who sent me the bill, and told them to resubmit and told them what the problem was. I promise you, it wasnt the Dr.s office intent to make your life a living hell. There are worse things that couldve happened, ya know?

izanmanyzanz · 03-31-2008, 09:15 PM

My pre approval letter stated one day and I was in for three. The insurances and my surgeons office said not to sweat the small stuff, that it was just that a pre approval. That once everything was said and done it would all be taken care of and it was. No problems at all. So don't sweat the small stuff and take care of yourself. It will all work out.

SueRN · 04-01-2008, 07:23 AM

Cari, relax and take a deep breath! I actually work for BCBSNC. THis may be a bit of a headache, but it is totally fixable. The worst case senario is the appeal would have to be done and after finding that it was a mistake on the part of the surgeon, it will be paid. What may have happened could have even been an error on the insurance end. What happens is that all WLS are loaded in the system as outpatient. This way, the case is forwarded to the prior review nurse to handle it. At that time, if the procedure is supposed to be inpatient, it is converted during the approval process by the nurse. Have there been times that I forgot to do this? Embarassingly....yes. Not many, but it happens. The biggest obsticle that you had to overcome was meeting the criteria to gete the surgery itself approved. This part is just coding and billing issues. I, myself, had a problem with a surgery I had this past decemeber. It was a revision. It wasn't billed as revision of scar but removal of excessive skin which requires prior approval, so it was denied. Heres the other thing. If a BCBSNC provider does not get prior approval, the member cannot be held liable for the surgeon fees. Not sure about the hospital cuz you may have signed stuff that excludes that. We are still working on getting it fix but Duke is aware it was their mistake. I paid the hopsital/anesthisia portion. I'm sorry you are going thru this, but don't worry. This is a very fixable mistake. Hang in there! Sue

rivi23 · 04-01-2008, 02:44 PM

Thanks Sue. It was a BCBSNC mistake, I found that out today. My surgeon filed an appeal, and the hospital bill is being resubmitted, and if it is denied again, they are going to file an appeal. My NP said that what you said is what happened. They forgot to turn it over to an in patient. So appeals are going through, and they all said the same thing. BREATHE. I just freaked out a bit, and I am in a bunch of pain still on my left hand side, and tired, and I went back to work this week, and I am just a wreck.

Thanks so much everyone for your advice, I really do need to learn to breathe! lol