Before surgery, my insurance company said I wouldn't have to pay. After surgery, that's changed. What now?
November 2, 2011 3:08 PM Subscribe
Before having surgery, I was told by my insurance company that my deductible had been reached, and that there was nothing for me to pay. After surgery, they amended that, telling me that in fact my deductible had not been filled at all for the present period, and I *would* have to pay. Am I just screwed here?
posted by Ash3000 to Health & Fitness (15 answers total)
The short version of a long story:
I recently had surgery to deal with a staph infection in my sinuses. Prior to surgery, my ENT's office contacted my insurer, Horizon Blue Cross Blue Shield NJ, who told them that my deductible had been reached for 100% for the year - my ENT's office passed that information onto me, and I went ahead with surgery. (The deductible having been reached made sense to me, given that I have dealt with several medical issues this year, including diagnosing and treating sleep apnea.)
After surgery, my ENT's office contacted me, very apologetically, telling me that HBCBS was now giving very different information. I called their helpline yesterday, and after an extended series of representatives, finally got HBCBS' story:
* My ENT's office spoke with their Provider Services department - Provider Services "isn't allowed" to say exactly what my deductible is, and can only provide an estimate, which they, according to HBCBS, told my ENT's office was an estimate.
* The 'estimate' they gave my ENT on how much of my deductible had been applied? 100%. The actual amount that had been applied? 0%. (The person I spoke to said that his guess was they checked 2010 instead of 2011.)
* Given that Provider Services was just providing an 'estimate,' and my contract apparently specifies I need to research the deductible directly with the insurer (i.e. not through my doctor acting as an intermediary), nothing against-the-rules has taken place here.
I'm going to have to pay somewhere between $1250 and $2500, at a time when money is on the tight side. To be clear, this could be much worse (I'm incredibly grateful that I'm not on the hook for tens of thousands of dollars or more), but I can't believe that it's okay for them to give blatantly inaccurate information to my ENT's office and then change their tune.
Am I just screwed here, and need to pay up? Are there any options that don't entail going down a legal route I will almost certainly lose? Thanks for your help here.