r/HealthInsurance • u/Tough_Cauliflower767 • Apr 11 '25

Claims/Providers 96k bill not covered

My wife and I are seeing a fertility doctor. The MD was adamant my wife needed surgery to clean out the fibroids and polyps in her uterus to improve conception. Prior to surgery, i confirmed over the phone that this was covered by my insurance. The fertility clinic said it's covered beside a $400 anesthiesia fee and good to go. Post surgery I got a bill for $3500 because apparently not everytning was covered. I reached out to the clinic and they don't know why it was denied. I sent an appeal to bluecross after that. Just got a notice in the mail that the appeal was denied and we owe 96k!?!?

It's after hours but I will follow up with them tomorrow. Praying this is a mistake. I feel like this is a he said she said with the insurance coverage. How can they tell me it's covered and then send me bills. Am I liable. Who os at fault.
Thank you

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15

u/Dancelifeaway Apr 11 '25

$96k is kinda high! My polyectomy/hysteroscopy was $25k. Double check and make sure they put the correct billing codes. Covered doesn’t mean it’ll be fully paid for. Has she met her OOP max?

7

u/AlternativeAthlete99 Apr 11 '25

it depends if the fibroids were able to be removed via hysteroscopy, some need to be removed laparoscopically, which would increase the cost of the bill. $96k is a lot, but mine was $76k because it required laparoscopic removal of some of the fibroids

1

u/Dancelifeaway Apr 11 '25

Mine was everything polyectomy/hystero, and lap. Luckily I paid nothing cuz I met my OOP already. That’s insane! Gotta love USA healthcare…

2

u/AlternativeAthlete99 Apr 11 '25

I thankfully had met my OOP max as well, so Ig was nothing, but i was shocked when I saw the overall bill if insurance didn’t pay anything

8

u/elsisamples Apr 11 '25

Billed amount is irrelevant in-network for covered services.

3

u/MoonbeamPixies Apr 12 '25

God even the out of pocket max should have long been met before the 96k, thats a ridiculous amount

1

u/ThrowAwayColor2023 Apr 13 '25

Yeah, something is very wrong here.

1

u/eec0354 Apr 11 '25

Your polyectomy was 25k??

1

u/Dancelifeaway Apr 11 '25

That’s what my Premera app says with a big “network discount.”