96k bill not covered

[u/Tough_Cauliflower767]

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

[u/Love_FurBabies]

Even though they verify benefits and state that it's covered, they do give a disclaimer that explains that the service must be medically necessary, and benefits are given based on the information you're providing. If you're Clinic is billing with a different diagnosis and different procedures, they may deem is not medically necessary. Reach out to your clinic and ask them to send all medical documentation so that they can support that it is medically necessary. They should be fighting this for you. If it's still denied, reach out to your State Insurance Commissioner and file a grievance.

[u/Tough_Cauliflower767 → u/Love_FurBabies]

Thank you. I believe they coded it as medically necessary to remove the polyps. The provider could not figure out why I was billed $3500 as they mentioned i should be $0 out of pocket minus the anesthesia fee

[u/Charlieksmommy → u/Tough_Cauliflower767]

The 3500 could be the anesthesia

[u/Skippiechic → u/Tough_Cauliflower767]

But did they get a prior authorization?