- Surgery Denied but Hospital covered?

[Guest guest]

I had a similar experience. My insurance was BC/BS, and they denied

my surgery. I was expecting to be on the hook for everything, but to

my surprise they paid the hospital bill and the anesthesiologist.

That was about 18k if I recall correctly (upper and lower).

I paid the surgeon out of pocket for 12k. Interestingly, when I

appealed the denial with my insurance company, they retracted the

payment to the anesthesiologist so I had to fork over another 3k! I

asked a BC/BS rep what that was all about and she said a review of

the claim found they paid the anesthesiologist in error. I asked her

if I appealed again (my first appeal was denied), would they decide

they shouldn't have paid the hospital bill either? Her answer was

that it was certainly possible, so I let it go at that point.

--Neil

>

> My insurance denied the lower jaw surgery that I need. But when I

> spoke to United Healthcare about having the procedure denied but

if I

> still have the surgery in an in network hospital would that be

> covered. They said yes it would be according to my insurance

plan.

> So I would have to pay out of pocket for the surgery but the

hospital

> would be covered. Has anybody had this similar experience where

you

> paid for the surgery but had insurance cover the hospitalization?

I

> thought if they denied the surgery, the hospitalization would be

> denied too. Thanks for any advice.

>

>

[Guest guest]

I had a similar experience. My insurance was BC/BS, and they denied

my surgery. I was expecting to be on the hook for everything, but to

my surprise they paid the hospital bill and the anesthesiologist.

That was about 18k if I recall correctly (upper and lower).

I paid the surgeon out of pocket for 12k. Interestingly, when I

appealed the denial with my insurance company, they retracted the

payment to the anesthesiologist so I had to fork over another 3k! I

asked a BC/BS rep what that was all about and she said a review of

the claim found they paid the anesthesiologist in error. I asked her

if I appealed again (my first appeal was denied), would they decide

they shouldn't have paid the hospital bill either? Her answer was

that it was certainly possible, so I let it go at that point.

--Neil

>

> My insurance denied the lower jaw surgery that I need. But when I

> spoke to United Healthcare about having the procedure denied but

if I

> still have the surgery in an in network hospital would that be

> covered. They said yes it would be according to my insurance

plan.

> So I would have to pay out of pocket for the surgery but the

hospital

> would be covered. Has anybody had this similar experience where

you

> paid for the surgery but had insurance cover the hospitalization?

I

> thought if they denied the surgery, the hospitalization would be

> denied too. Thanks for any advice.

>

>