Hi guys. I apologize in advance for how long this post is going to be. I have been going back and forth between the hospital where I had surgery, and my insurance company over the last 2 weeks. I haven't found many answers online or situations similar to mine, so I figured I'd look for help here.
I had a laparoscopic bilateral salpingectomy (aka had my fallopian tubes removed) on September 16. Per my insurance policy, contraceptive care is considered a preventive care service and is covered 100%. It specifically states: Prescribed Contraceptive Services (Includes diaphragms, intrauterine devices (IUDs), implantables, injections and tubal ligation) when in-network are at no charge (deductible does not apply).
I checked with my insurance company prior to my surgery, and a bilateral salpingectomy falls under a tubal ligation. I was reassured that it would be covered at 100%.
Rewind to two weeks ago, I receive two bills in the mail from the hospital where I had surgery. My insurance was billed, however they did not cover my surgery 100%. I am being billed for a whopping $4,344.96. I was quite shocked as I was under the impression that my surgery would be covered 100%. I immediately called my insurance company and was reassured that yes, it should be covered entirely. The gal I spoke with stated she'd forward my claims onto another department that could look further into the charges. I finally got a call from her on Monday this week, and she tells me that my surgery was coded incorrectly. She provided me a list of 8 or 9 different CPT codes that would've been acceptable and advised that I contact the hospital's billing department and relay this information.
So I do just that, call billing and explain my situation. The gal from the billing department tells me that there's nothing they can do and they can't/won't change the coding on my bills. So I call the OBGYN office where my surgeon works. I explain my situation again, and am now told that I'm responsible for 30% of the total bill per my insurance plan, because it was an "outpatient surgery".
Sigh. I call my insurance company AGAIN. Now I'm being told that if the surgery had been billed as a preventive care service that it would've been covered at 100%. They once again recommend that I contact the hospital's billing department with that information, and if they are unwilling to help me that I need to file an appeal through the insurance company.
Once again, I call the hospital's billing department and explain that the surgery should've been billed as a preventive care service in order to be covered 100%. And I'm told the same thing again - that there's nothing that can be done, except that now my information is being passed on to a supervisor to have her "try and explain things in a way that I'll understand" and that she'll call me when she has time.
Before I file an appeal with my insurance company, I wanted to come here for advice to find out if there's anything else I can do to dispute these charges. I would've never had this surgery had I known that I'd end up having to pay nearly 5k out of pocket due to billing issues. I don't have that kind of money. Any help/advice is greatly appreciated as this whole situation has me uncomfortably anxious.
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