UPDATE: Anthem won't cover our surgery unless it's performed by a psychiatrist

[u/takenorinvalid]

I previously posted about the trouble we were having getting pre-authorization for my wife's surgery.

Our insurance explicitly covers the insurance my wife needed, but, when the hospital requested prior-authorization, they were repeatedly told the surgery wasn't covered at their facility. So I asked them for a list of doctors that are authorized to perform it -- and they sent me this, which says we'll need to get our surgery performed by one of Good Company Therapygroup's clinical social workers.

Clearly, someone at Anthem messed up the codes and assigned the wrong list of approved providers to this surgery.

I followed the advice of commenters on the last post and worked with our company's insurance broker to get this worked out, and, after about a month of fighting, Anthem agreed to give prior authorization.

Great!

Except that, when the surgery was over, we were sent a bill for $53,735.90.

I have the prior authorization -- it's right here -- but, now that we've done the surgery, we're being told we have to pay 100% of the surgery charge on our own. It doesn't even go toward our out-of-pocket maximum.

We're fighting with the insurance and the hospital through the broker again, but insurance is just saying "We'll forward off your concern" and the hospital is telling us we have 30 days to pay before this goes to collections.

Never use Anthem.

What do I do at this point?

[u/mamaluvscake2]

Thank you for answering- I just feel it’s criminal not to know if something so expensive will be covered. Scary.

[u/Good-Philosopher3039 → u/mamaluvscake2]

I agree with you. That’s why I left the field. I couldn’t do it anymore. It’s so complicated and stressful for the patients. It’s not right. Please call the ins co and document name, date, time and have that available if need be. Please focus on getting healthy. If something does happen, please reach out to me, and I’ll help you.

[u/mamaluvscake2 → u/Good-Philosopher3039]

Thank you so so much

[u/Impossible-Guava-315 → u/mamaluvscake2]

Reference numbers for every call. So call again on if it needs a preauth and if it's a covered benefit. Also ask how much you will pay. You may have to pay an allowed amount for certain things.