California:
My husband needed prostate surgery and waited 3 long painful months until his deductible was met so he could afford to have the surgery needed using a green light laser. The surgeon's office told us repeatedly that we were pre-approved for the surgeon and the hospital who had the needed laser equipment. One month after the surgery, we received a bill for over $20,000 for the hospital's portion of the surgery from the hospital. We then found out the hospital is not a contracted provider and the doctor's office never got the pre-approval. We then met with that surgery scheduling dept who deals with the preapprovals and they told us this is typical and happens all the time and all they need to do is make a few phone calls to appeal and the hospital bill will be paid for by the insurance company. They even provided us with the documents showing we were not preapproved and that the insurance company would not pay the surgery prior to the surgery. Sadly, we did not become aware of this by the doctor's office until a month after the surgery. We did tape record the conversation so we could remember the details. Within one hour of leaving the doctor's office after discussing this "easy appeal process that they would do for us", that same doctor's office called us and told us there was nothing they could do to help us with the appeal and we were on our own. It took 2 months to compile information for the appeal showing the closest green laser was 113 miles away from our residence. We received a denial letter from the insurance saying that if we were going to have surgery "out of network", we needed a referral and they would have paid for the surgery. Since we were told we were preapproved, how would we have known to get this "out of network" approval and now we have been thrown under the bus with a $20,000 bill that we are being asked to pay. Is this criminal intent to commit fraud by the doctor's office? What recourse do we have? We were stunned at this outcome.
We know you can not use the taped conversation in a court of law, but can you use it in a mediation situation to prove our point that the doctor's office did not tell us the truth prior to the surgery? Isn't the doctor's office responsible for that bill since they lied to us?
My husband needed prostate surgery and waited 3 long painful months until his deductible was met so he could afford to have the surgery needed using a green light laser. The surgeon's office told us repeatedly that we were pre-approved for the surgeon and the hospital who had the needed laser equipment. One month after the surgery, we received a bill for over $20,000 for the hospital's portion of the surgery from the hospital. We then found out the hospital is not a contracted provider and the doctor's office never got the pre-approval. We then met with that surgery scheduling dept who deals with the preapprovals and they told us this is typical and happens all the time and all they need to do is make a few phone calls to appeal and the hospital bill will be paid for by the insurance company. They even provided us with the documents showing we were not preapproved and that the insurance company would not pay the surgery prior to the surgery. Sadly, we did not become aware of this by the doctor's office until a month after the surgery. We did tape record the conversation so we could remember the details. Within one hour of leaving the doctor's office after discussing this "easy appeal process that they would do for us", that same doctor's office called us and told us there was nothing they could do to help us with the appeal and we were on our own. It took 2 months to compile information for the appeal showing the closest green laser was 113 miles away from our residence. We received a denial letter from the insurance saying that if we were going to have surgery "out of network", we needed a referral and they would have paid for the surgery. Since we were told we were preapproved, how would we have known to get this "out of network" approval and now we have been thrown under the bus with a $20,000 bill that we are being asked to pay. Is this criminal intent to commit fraud by the doctor's office? What recourse do we have? We were stunned at this outcome.
We know you can not use the taped conversation in a court of law, but can you use it in a mediation situation to prove our point that the doctor's office did not tell us the truth prior to the surgery? Isn't the doctor's office responsible for that bill since they lied to us?