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Topic: Anesthesia denied by insurance

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Sep 23, 2011 07:53PM, edited Sep 23, 2011 07:54PM by Hadley

Hadley wrote:

I just got a bill for $3000.00!!!!!!!! Insurance denied my anesthesia for my surgery. ARE YOU KIDDING ME??!! I just left them a message asking how are you supposed to have your neck ripped open, have an attempted tumor removal that could or could not be a met because none of these damn doctors can tell me, plus have part of a vertebrae removed AND have 6 pieces of hardware shoved in there AND STAY AWAKE FOR IT!!!!! I said this is absolutely insane and someone needs to call me back first thing Monday morning. UNBELIEVABLE. Log in to post a reply

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Sep 23, 2011 08:01PM sundermom wrote:

Insurance companies are ridiculous! I've had to make more phone calls and write more letters questioning coverage since being diagnosed with breast cancer than in my entire adult life. It's frustrating and not the best use of my time. Your claim sounds pretty straightforward so I'm sure you'll get it overturned. Good luck!

Dx 11/8/2010, IDC, 2cm, Stage IIb, 2/32 nodes, ER+/PR+, HER2-
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Sep 23, 2011 08:05PM sheila888 wrote:

Hadley...I'm sure it's a mistake maybe the wrong code number was submitted.

HUGS

Sheila♥

Dx 4/8/2005, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2+
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Sep 23, 2011 08:10PM 208sandy wrote:

Guarantee it's the wrong code number - don'tcha just love people who have no common sense.

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Sep 23, 2011 08:20PM lauri wrote:

Or they're saying the anaesthesiologist was "out of network" -- hello, I never met the guy to ask about his billing program, just assumed because the hospital and surgeon were in-network it would be OK.  My insurance paid and then I got a bill for the difference -- I sent back a letter saying they should take what Blue Cross paid, and I didn't hear from them again.

But bad coding sounds like the most likely reason, and one that's easy to fix (although it may take a number of calls/letters until you get someone who will actually look at what was done and what it was coded for.)

From the ashes of disaster grow the roses of success

Dx 3/8/2006, ILC, 6cm+, Stage IIIb, Grade 2, 11/12 nodes, ER+/PR+, HER2-
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Sep 23, 2011 08:35PM 1Athena1 wrote:

I'm sure it's a mistake.

Think of the flip side: Your insurance company is essentially authorizing surgery without anaesthesia. Ask them if that's what they really meant to do, or if they'd like you to seek clarification from your state's department of insurance regulation on whether it is ethical to encourage wide awake neck surgery....Cool

but I'm sure (hope) it's an oversight. 

Anyone diagnosed with cancer should learn to have a healthy disrespect for statistics. Statistics are maths. It's the science which still eludes us.

Dx 3/2009, IDC, 3cm, Stage IIb, Grade 3, 3/8 nodes, mets, ER+/PR+, HER2-
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Sep 23, 2011 10:43PM cycle-path wrote:

Oh, good call Athena. Yep, tell them you're going to ask the state department of insurance regulation about unanesthetized neck surgery. That's sure to make someone's heart skip a beat!

I hate bureaucrats. 

I am an Uppity Woman. Don't like my posts? Put me on IGNORE.

Dx 12/10/2010, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+
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Sep 23, 2011 10:56PM sewingnut wrote:

Sounds like a billing error.  If you call the insurance co and ask how it was billed they will tell you.  Then ask them how it should be billed to get paid. I had to do that when a radiology procedure was denied  and I was sent the bill. In my case it was an incorrect modifier.  The office resubmitted and it was paid.  Some SOB's will threaten you with collections, that's when you push back.

Dx 12/2010, IDC, 5cm, Stage IIIa, Grade 3, 1/7 nodes, ER-/PR-, HER2+
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Sep 23, 2011 11:54PM coraleliz wrote:

I guess my anesthesia bill for $2,000 was good deal. Hospital & BS were in network, anathesia was not. My insurance company eventually paid $800.

I called the anesthiesiologist(too pissed of to bother with correct spelling here) & was told to take it up with insurance company. Insurance company told me that $800 was all they would pay when I phoned. Called back to tell anesth office this. I was told to write my insurance company. I did. They replied "no additional payment" twice!

Sent a letter to the anesthesiologist stating I could not pay the remaining $1200 due to my continued accrual of medical bills related to my diagnosis. Waiting for a reply................At this point I think your situation is more hopeful than mine. Good luck!

Dx 2/28/2011, IDC, 1cm, Stage II, Grade 1, 2/4 nodes, ER+/PR+, HER2-
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Sep 24, 2011 11:43AM Chickadee wrote:

Some doctors have found a way to increase their revenue by not participating in insurance.  We had a similar thing happen years ago when my husband went to a 24 hour clinic and they called an ambulance and sent him to the emergency room because his heart rate was elevated.  We got a bill from the emergency room doctor who didn't participate with our insurance.  So if you go to an emergency room in some different place from home you are supposed to ask before they treat????  Yeah right.  Although at the time I paid the $300 he wanted I got good advice going forward from someone else who experienced the same thing......call your state insurance regulators and refuse to pay it.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012

Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Sep 24, 2011 12:49PM Hadley wrote:

Thanks ladies. I know the bill says he is part of the hospital's name anesthesia associates. So IF they are trying to pull something I would say that is highly unethical and just not right. After I calmed down I thought the same thing, someone has checked the wrong box or punched in the wrong number somewhere. All I know is if they give me grief over this, they will be getting a check that is pay to the order of f$%^ you, in the amount of kiss my @$$. After all these freaking doctors have put me through, they STILL can NOT tell me what this thing is and now try to stick me with this bill? It's a joke. Plain and simple. I will call the insurance board Athena but you know what.....when I had a different job and before I was diagnosed, I had to fight with that insurance for 8 months to get a reduction approved- I thought hey less boob less chance of getting cancer and yeah that worked out great- but I was told by the insurance board because it was a privately run plan owned by the hospital I worked for at the time- which is the same hospital where I had all my surgeries- there was nothing they could do about it. These people don't care how sick you are, they will give you the run around all because they just don't give a crap.

Always go with your gut, you know your body better than anyone.

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Sep 24, 2011 01:04PM, edited Sep 24, 2011 01:06PM by buttercupwithab

Just wanted to add to what everyone else is saying.  If they didn't code it correctly or preauthorize correctly, this could be the result.  Also, I've gone to three Oncs/BC clinics during the 5 years I've had BC.  The second clinic could never get their bills right.  On one occasion, I had three different bills in appeal at the same time.  One was from March and was finally settled in October - it was for around $300.

For as much as I've observed people complaining about insurance, all my problems have been with hospitals/clinics that could not get their bill right.  During the incidents referenced above, the insurance company had to initiate three way phone calls to me and the clinic to tell them how to correct their bills in order to get them paid.  Don't hesitate to do this.  The insurance company is in the position to make it clear to them that this is the only way they will be paid.

Good luck on this - I'm sure it will be resolved! 

PS  It does make you mad that you should have to do this when you have your own health to look after - I used to grit my teeth just to get through some of this paperwork.

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Sep 24, 2011 01:13PM peggy_j wrote:

FWIW, I've heard that some anesthesiologists are not "in network" even if the doc or hospital is. How are we supposed to know that and prevent that? Arg! I have no idea but someone gave me this tip-off and I made sure to verify before my surgery. But....you should still get a partial reimbursement, even if the doc's out of network, so if they paid $0 of the bill, it sounds like a billing error. And of course, you always have the option to refuse to pay and force them to do a write-off.

This year my insurance refused to pay one of my MO's office visits. No explanation. Had to call twice to get it fixed.  (BTW, when it's pending with your insurance, you may want to call the doc's office; they can flag it so it doesn't show up as past due)

My funniest billing error (unrelated to BC): I was traveling and needed to get special shots. They paid for the shot but not the doctor's visit to get the shot (huh?). I had to call three times to get it straightened out. 

Dx 2/2011, IDC, <1cm, Stage Ia, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Sep 24, 2011 01:14PM motheroffoursons wrote:

Don't panic yet.  The anesthesiologists have found a way not to participate in the insurance program.  Your insurance will straighten it out, as you do not ask the anestheiologist at your in network hospital with an in network doctor if he is in network. I had the same problem with a major susrgery. My statement scared me to death too, and then the insurance paid the whole bill, negotiated at their rates.  That will probably happen with you to when you call up.

God does not promise you tomorrow, he promises eternity. Sharon

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Sep 24, 2011 01:17PM Denise2730 wrote:

Hate insurance companies! Hadley suggest to them that the next time they have to be cut open try and do it without anesthesia. Asshats.

DMX 8/11/11 - TE's put in. Exchange date was December 16th. Hate them and had them redone by a different PS in June, 2012. They look so much better. Still waiting for nips & areolas.

Dx 4/29/2011, ILC, 1cm, Stage IIa, Grade 2, 1/7 nodes, ER+, HER2-
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Sep 24, 2011 04:54PM Medigal wrote:

I wonder how many sane people are locked away in mental institutions due to fighting with their insurance companies.  I had a similar problem cause anesthethiologist was "out of network".  How in blazes are we going to know to ask "every" person who handles us in a hospital if they are "in network".  I told the insurance company I thought it was up to the hospital to make sure when they take our insurance they only allow "in network" people work on us.  Turned out after all my screaming, it turned out the people were "in network" but the billing idiot didn't notice it!  So try to calm down and make sure you don't let them charge you for anything you don't owe.  Hospitals are a true nightmare when the billing starts.  Good luck!

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Sep 24, 2011 09:25PM cycle-path wrote:

Medigal, your assertion that people could be in mental institutions after dealing with insurers made me LOL. It's like "Going Postal." We need a new term for it. Let's put our thinking caps on!

I am an Uppity Woman. Don't like my posts? Put me on IGNORE.

Dx 12/10/2010, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+
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Sep 25, 2011 12:11AM LisaAlissa wrote:

Insurance psychosis?

Psychosis is defined (non-medically) in the Oxford Dictionaries as "a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality "

Sort of an "Alice in Wonderland" experience...

LisaAlissa 

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Sep 25, 2011 08:22AM NancyD wrote:

It's a usual courtesy in the hospitals I've been to that the anesthesiologist stops by to see you before surgery...at least the good ones do...to go over your medical history. But I had one bad experience many years ago so I've started taking the time then to ask them then if they are particiapting drs in my insurance. I even asked before I selected the hospital (I had a choice of a couple), and picked the hospital that said their anesth. were all employees of the hospital, and as such participated in whatever insurance programs the hospital was in.

I'm not a complete idiot. Some parts are missing.

Dx 2/22/2008, IDC, Stage IIIa, Grade 2, 4/10 nodes, ER+/PR+, HER2-Chemotherapy 03/22/2008 Adriamycin, Cytoxan, Taxotere
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Sep 25, 2011 01:06PM Medigal wrote:

Cycle:  I like the term "Going Medicrazy!"  Kinda like I feel whenever I get on the phone about a medical bill. 

Nancy:  What you are doing is about the best way to protect oneself with these unexpected bills but what I told the main hospital my docs use is that "they" should do the work.  I think if the hospital is in network with all these plans then they need to make sure "every" one they use signs up to accept the same plans.  I was told it is no big deal for them to do this but the hospital just doesn't bother to tell them to sign up! 

Are you aware that if you are unconscious when you arrive at the hospital and can't tell them NOT to use out of network workers on you that the insurance company can't charge you the Out-of_Network charges?  I went to battle with them over something that happened to my DD and she arrived unconscious in an ambulance and had no way of stopping them from using out of network people.  Her insurance company didn't hold her responsible for the thousands of dollars of bills and explained this to me.  Something to know if you can't speak for yourself.   Have a nice day ladies!   Her medical plan followed this procedure but if yours doesn't, don't pay without a fight, imo.

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Sep 25, 2011 02:17PM cycle-path wrote:

How about Insur-ichotic?

Here's an article that has some relevance to the denial of anesthesia question, but, for Californians, is relevant to all sorts of insurance denial issues.

When a health plan decides not to provide coverage for a treatment based on a lack of medical necessity, the Department of Managed Health Care may be able to help.

The DMHC administers an Independent Medical Review program which allows consumers to challenge health plan denials that are based on either a lack of medical necessity or a treatment being considered experimental or investigational in nature. Disputes that are qualified for an IMR are sent to an independent physician reviewer or panel of reviewers. If the reviewer(s) conclude that the denied service would provide the consumer with a more beneficial treatment plan than the one offered by the health plan, the denial is overturned and, by law, the health plan must provide coverage for the requested treatment.

Read more: http://www.sacbee.com/2011/09/25/3931479/lymph-node-transplant-was-denied.html#ixzz1YzPZnDD3

I am an Uppity Woman. Don't like my posts? Put me on IGNORE.

Dx 12/10/2010, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+
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Sep 25, 2011 02:29PM mrsnjband wrote:

I got so tired fo calling the insurance & doctors when I was in chemo.  It is rediculous to have to fight over this stuff.  My insurance tried to not pay 100% of my last to radiation treatments. I had long met my out of pocket expenses that year. They finally did pay.  

I am thankful the last doctor I went to said they would make sure everyone that had anything to do with my surgery would be in my group.  Thank God!

The error is either coding or out of network. But I would fight it.

Sorry you have to deal with this cr@p. NJ 

Norma June, Bi-lateral MX 2008, Bi-lateral DIEP 2011

Dx 1/10/2008, IBC, <1cm, Stage IIIb, ER-/PR-, HER2-Chemotherapy 01/25/2008 Adriamycin, CytoxanChemotherapy 03/10/2008 TaxolChemotherapy 05/29/2008 TaxotereSurgery 07/10/2008 Mastectomy (Right); Lymph Node Removal (Right); Prophylactic Mastectomy (Left)Radiation Therapy 08/11/2008 ExternalSurgery 08/15/2011 Reconstruction: DIEP flap (Right)Surgery 08/15/2011 Reconstruction: DIEP flap (Left)Surgery 12/12/2011 Reconstruction (Left)
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Sep 25, 2011 02:32PM sandibj wrote:

OMG!!  I also just hope the wrong code was used on the paperwork.  You're going through enough to put up with this BS too! 

Dx 12/15/1995, 1cm, Stage II, 10/20 nodes, ER+
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Sep 25, 2011 02:49PM, edited Sep 25, 2011 02:49PM by CoolBreeze

I am so lucky.  I have never had one single insurance issue in the past two years.  Never a test denied, never a treatment questions - nothing.  I do what my doctors tell me and I don't have to worry about anything else.

I'm really sorry some of you have this stress on top of everything else. 

Ann's cancer blog: www.butdoctorihatepink.com .....multicentric/multifocal IDC/ILC+DCIS/LCIS/ADH Official dx? "Your breast was a mess." ~UniMastectomy/Chemo/Herceptin/Tamoxifen/Recon Almost Done! Oh wait. mets to liver 5/21/11 Now Stage IV

Dx 8/17/2009, IDC, 4cm, Stage IIa, Grade 3, 0/3 nodes, ER+/PR-, HER2+
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Sep 25, 2011 03:24PM D4Hope wrote:

Keep fighting. I had the same thing happen to me when  I got a bill for anesthesia for thousands of dollars from when I had my BMX with immidiate diep reconstruction. I called the insurance company and asked them how I was supposed to stay awake for 12 hours while I had my breasts removed, and my new one's made from my stomach fat. They called me back within a half hour to say that it was a mistake.

Every day I wake up is a good day.

Dx 2/2/2009, IDC, 2cm, Stage IIa, Grade 3, 0/8 nodes, ER+/PR+, HER2-Surgery 03/29/2009 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection (Right); Reconstruction: DIEP flap (Both)Chemotherapy 04/09/2009 Adriamycin, Cytoxan
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Sep 27, 2011 09:43PM, edited Sep 30, 2011 10:57PM by Hadley

Well ladies I got to the bottom of it. They billed my previous insurance which termed earlier this year instead of my current insurance. I used to work for the hospital I had my surgery at so I wondered if that had anything to do with it.....meaning they probably see that insurance a lot. I don't know, they just said it would take 4-6 weeks now for the claim to be paid. Either way I wish they would be more careful bc that gave me a serious anxiety attack.

Always go with your gut, you know your body better than anyone.

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Sep 28, 2011 02:15AM cycle-path wrote:

Yes and they got US all excited too! 

Frankly, I think some of us enjoyed the righteous indignation. I know *I* did. Surprised 

I am an Uppity Woman. Don't like my posts? Put me on IGNORE.

Dx 12/10/2010, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+
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Sep 29, 2011 08:02AM, edited Sep 29, 2011 08:02AM by Fearless_One

Coolbreeze, same here - two years, lumpectomy, scans, chemo, rads, mastectomy, reconstruction and robotic hysterectomy and I never even had to make a single call.    Guess I just got lucky.

Hadley, glad it has been straightened out for you....

lump/chemo/rads/hyster-ooph/mastectomy/implants

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Sep 29, 2011 09:40AM LuvRVing wrote:

One of the best things that my insurance company did for me was to assign a nurse "navigator" - case manager.  That woman has been a godsend.  She calls to check on me, and she has been helpful in resolving the few issues that I had with getting payment on claims.  Contact your insurance company, ask if they offer this service and take advantage of it, if it is offered.  It will make your life so much easier! 

Hugs,

Michelle

Michelle - read my blog at www.mch-breastcancer.blogspot.com - Be kind to one another!

Dx 6/15/2010, IDC, 1cm, Stage I, Grade 3, 0/4 nodes, ER-/PR-, HER2-Dx 3/29/2011, IDC, 4cm, Stage IIIb, Grade 3, 4/21 nodes, ER-/PR-, HER2-Dx 5/11/2012, IDC, Stage IV, Grade 3, mets, ER-/PR-, HER2-
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Sep 29, 2011 06:53PM Emaline wrote:

Every single one of my treatments was denied the first time around.  The first time I called my doctors office and they said don't worry, insurance companies do this all the time. Then I get another letter a few days later saying I was approved.  Okay dokey.  My friend had her MX with immediate reconstruction and three months of expansion no problems with her insurance. Her doctors office goes to precert for her exchange surgery and she is denied. Told she has gone over her alloted amount of treatments and it is up to committee review.  She still doesn't have an answer. What BS these insurance companies put you through.

Dx 4/4/2011, DCIS, 6cm+, Stage 0, Grade 2, 0/5 nodes, ER+/PR+
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Sep 29, 2011 08:34PM cathy_stanford wrote:

Oh, the frustrations with health insurance companies!! They make money by denying care and hoping we just give up instead of questioning them. One thing would be to deliver care based on the diagnosis rather than specific tests or services. For example, it is well-established medical practice that certain breast cancer patients can be successfully treated with Tamoxifen for 5 years after surgery to prevent cancer. Yet, under my old HMO plan, I had to go every 6 months to my primary care physican and get another referral to my oncologist. The primary doctor added nothing to my care, except costs--yet it was required by the insurance company. Trimming unnecessary costs such as this one maximizes quality of care! We have a great opportunity to help trim these costs and stand up for quality care. The new state health insurance exchanges being set up need pro-consumer advocates that will stick up for patient needs. Tell the true stories of insurance craziness right now for maximum impact!

cathy

Dx 11/1996, IDC, <1cm, Grade 1, 0/2 nodes, ER+

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