Mar
24
MM asked:
I had surgery last year. Prior, the surgeon’s office handled the insurance and sought pre-approval on my behalf, and I did receive a pre-approval letter in the mail. The surgery was back in 9/2007, and ins. didn’t pay the bill. When I asked the surgeon’s office about it, since they handled the pre-approval, they said it was normal to take a long time and it must be sent through several offices. Well, I finally got a claim copy from my insurance company in 4/2008 that shows that they did not pay one penny of the surgery and that it is my responsibility. I asked the surgeon’s office about this, and of course, they now have someone new working there who is supposedly trying to fix it and won’t give me a straight answer. I called my insurance company who is sending the claim back through again with my approval letter attached. What are my options in this situation for getting this bill paid? Should I seek legal representation? Is there a statute of limitations on payment of claims? Thanks
Laurene
I had surgery last year. Prior, the surgeon’s office handled the insurance and sought pre-approval on my behalf, and I did receive a pre-approval letter in the mail. The surgery was back in 9/2007, and ins. didn’t pay the bill. When I asked the surgeon’s office about it, since they handled the pre-approval, they said it was normal to take a long time and it must be sent through several offices. Well, I finally got a claim copy from my insurance company in 4/2008 that shows that they did not pay one penny of the surgery and that it is my responsibility. I asked the surgeon’s office about this, and of course, they now have someone new working there who is supposedly trying to fix it and won’t give me a straight answer. I called my insurance company who is sending the claim back through again with my approval letter attached. What are my options in this situation for getting this bill paid? Should I seek legal representation? Is there a statute of limitations on payment of claims? Thanks
Laurene
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Comments
4 Responses to “Insurance will not pay pre-approved surgery–what should I do?”
just calm down. sometimes insurance companies are like that and it may take a while to sort everything out. I do hope though that you sent a copy of the pre approval to the insurance and not the original. hang on to that with your life in case something happens and you would have to sue!!
When dealing with insurance companies you need to be tough. They are trying not to pay the bill and you got to get them to do so. If you have access to some legal representation, go for it and nail the insurance company as they should be ashamed of themselves not paying this bill. If you don’t know a lawyer, use consumer advocate that some state governments have or talk with some knowledgeable people in your area about what to do.
Don’t get a lawyer, they’re working on it… my last one took 16 months to get resolved, same exact thing. It’s just their way of hanging onto their money a little longer.
Keep all the documentation, and wait for them to process it…again!
Statute of limitations would apply on the guy holding the bill suing for payment, depends on the state you’re in but if it’s over small claims amount that’s usually 3-5 years for a civil action.
Get some advice from a lawyer.Unfortuntely this is becomming all to often the case with insurance company’s no matter how high the premiums you pay.