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
7
u/AnonymousGirl911 Apr 11 '25 edited Apr 11 '25
Always always always record phone conversations with your insurance company. They record you, but they sure as hell aren't going to use said recording to prove YOU right.
Some states have "two-party consent" laws, meaning both parties must agree to being recorded. You agree when you call your insurance because there is always the automated "this call may be recorded for quality and training purposes".
As soon as you get on the phone, start that recording. When you get on the phone with an agent you inform them that you are recording the conversation just as they also are recording. Get their name, if they have an ID number get that too, and the department they work for.
I always do this and it helped me when they tried to fuck me over one time. I said "that's interesting because I have this recording where I spoke with [insert name, id number, and department] on [insert exact date and time] and they said [exact verbatim statement]."
All of a sudden they said "😃 oh yeah now I see your plan covers that!"
🤔 interesting how you "figured it out" once you realized you got caught
Also, get things in writing. Ask for both the insurance company and the clinic to give verification of what your out-of-pocket cost will be and what the insurance will cover.
If all else fails after doing all that, threaten with legal action. Get a lawyer and send them a scary legal letter with all your documentation.