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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u/chickenmcdiddle Moderator Apr 11 '25

Start with the documents produced by your insurer—have you received an EOB (explanation of benefits) from them yet? It details the claim(s) submitted by your care provider and if it’s denied, will have reasons listed.

If you don’t have a copy of the EOB, log on to your insurance portal and take a look for a digital copy. Then, upload a copy here with your name / address / other sensitive date blurred or blocked out. This will contain key information regarding why things were denied and what your liabilities are.

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u/Tough_Cauliflower767 Apr 11 '25

Thank you so much. I will follow up tomorrow

14

u/Local_Historian8805 Apr 11 '25 edited Apr 11 '25

I have heard stories of patients getting bills for open heart surgery when they had a different opera operation, so please review the eob before you pay anything

Edit. Fixed auto cucumber’s shirt

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u/Tough_Cauliflower767 Apr 11 '25

Thank you. I will.

1

u/ShotCode8911 Apr 16 '25

Just a heads up, if you ever get a bill for insurance, always check the billing codes against your EOB. Medical billing code errors happen like over 50% of the time.