Was your surgery paid for by insurance? Or not?

[KBear]

I have noticed that it seems like many insurance companies are denying surgeries and appeals prior to surgery; but then will pay some or all after surgery. I am just curious is this is common or not. Mine denied me and my appeal, saying my age was a factor (so young, didn't know how long ADR would last) and that it wasn't proven technology. I was in a clinical trial that paid for it, however they do file on insurance, just to see if they can get anything. To my surprise, I received and EOB showing my insurance (who so adamantly denied me) paid for 10 or 15K of the surgery. I absolutely could not believe it. Since then I have heard of several others who went ahead with surgery, even though insurance said they wouldn't pay, but then insurance paid. I wonder if they deny up front, hoping that you will just change your mind or not do it, but then pay out of fear of lawsuits or something??? I don't know, it makes no sense to me. I would love to hear of others experiences with this.

[runagain]

KBear,

In my case, the answer was "NO" after surgery too.

Currently, the answer is "NO" although they have approved others. I am talking about blue ^^^^.

I have a list of 60 or more approvals. Didn't do me any good. However, I did fight for health care reform and despite everything, maybe one day we will be better off. I just want to see the decision put back into the doctor's hands./

but I am barking up another tree right now.

You were smart and diligent to pursue the trials. I know from what you have said that was no piece of cake. It takes guts to fight for what you believe is right.

My L4/5 disc is great. I don't see the point of these people because a doctor can mess up a fusion or an ADR--it is all the same. Why Aetna has the foresight to cover, I don't know. I wish to God I had Aetna.
But unfortunately I do not. If I knew my back was going to go, I would have had Aetna.

But you don't know that. Now it has taken three years to learn about what I know about spines and all the beautiful ramifications. And I am still learning. I am thinking of specializing in the spine/pain area field when I go back to school to get another degree.

But now I have to deal with this stuff. Frankly, I think you really take a chance when you have surgery, but living in pain is no bowl of cherries, either. People have to know that doctors are not omnificent. Sometimes things happen and there is no one to blame. That's why I think getting second opinions and educating yourself is the best thing you can do before you consider surgery.

That's my two cents.

Takey care,

R

[trkdoc714]

I had a lot of my claim paid for by Aetna. They declined to pay any part of the overnight stay in the hospital as they felt it could have been performed as an outpatient procedure.

My time to appeal expired while I was tied up taking care of personal issues for my family.

Good news though, a VP in HR has decided to take another look into the case.

[runagain]

Alright Bob!!!!!!!!!!

Good news for you.


runagain

[Jack-of-all-trades]

My insurance company had no problems paying for my surgery, all but about 2% which was my co-pay.

The hospital on the other hand has been playing a real shell game over charges. In June, my balance was $0.00. In July it was $680.00. They say I owe it but can't give a reason why. I did catch several charges that I know I didn't receive.

[lolenona]

Well, my doc said that they needed pre-authorization but then my insurance company (BCBS) told me that hey do not require pre-authorization. I only had to meet the following criteria:

1. Over the age of 18
2. had symptoms for over 4 months and had failed conservative treatment
3. Nerve pain or compression

I called my insurance company to verify this prior to surgery and was told that it is approved due to the medical necessity and that I would only have to pay my co-insurance of $1,000. Let's hope they stick to this when they send me the bill.

[JessicaS]

My injury was under work comp, who denied further medical treatment last year. Fortunately, my husbands' insurance (health alliance then BCBS) has paid all but copays ($15). We are fortunate enough to have a 0 deductible because my husbands' employer has the best plan they offer. Thank goodness because otherwise I dont know how we would have done it, with 7 kids and me being unable to work now. I havent seen bill from surgery yet though....

[Jack-of-all-trades]

I feel what will ultimately be owed depends on a persons policy. By the time December rolled around, I had already met my $2,000.00 general deduction for labs, X-Rays (MRIs & CTs add up fast), etc. Own admision, I paid an up front charge of $1,200.00 to the hospital and $600.00 to the physician's clinic. After surgery, once all bills were tabulated, I owed additional charges for "extras". Seems my original bill was somewhat like buying a stripped down Chevy and my final bill was more like a Mercedes. I had, so they say, more bleeding than normal due to a nicked artery. Stuff like that happens as everyones anatomy is a bit different. Anyway, they run my bled out blood through a gizmo called a cell saver an put 3 units back in. Plus blood administration sets, plus follow up CBCs and H&Hs and others.

In addition to my co-pay, I owed a co-insurance fee. All in, I owed the $1,800.00 plus another $1,400.00 or so.

If I were you I'd get something in writing as most of the first tier people in hospital billing and the insurance companies tend to blow a lot of smoke just to get rid of the caller if they don't have an answer handy. I found this out through experience. Depending on who provides the service, their may be additional charges for anesthesiology or Radiology services as some hospitals sub-contract these out and don't bill for them through the hospital but let the sub-contractors bill them.

If you take opioids going into surgery, make sure you have some sort of understanding with the surgeon as they tend to use pre-written post-op orders and you will not have enough pain meds. This needs to be re-enforced. Prior to my surgery, I thought I made this clear but a resident who I never met handle post-op pain control and I was actually in withdrawal until my surgeon made his rounds. When you go for your anesthesiology pre-op I'd mention this to them as well as sometimes they give meds to reverse what you get during surgery to get you breathing. Most likely it is not something to reverse the narcotic long term but it pays to everyone involved informed.