Medical bills- for Dh emergency surgery

Totally off twin subject, but I know the folks here are a wealth of knowledge. New Years Eve day DH was sent to the emergency room at our local hospital. The acute care (his first stop) Dr suspected appendicitis - after being admitted to emergency a scan was done and they determined that he needed the appendix removed. It was going to be an "easy" larpo-3 little cuts. After the first incision, Dr could see that DH's appendix had ruptured. This required an incision from belly button on down (12 inches). An overnight stay turned into 7 nights at the hospital.
So now the bills are showing up. Luckily we have a low deductible plan- hospital bill is small compay. The problem is the surgeon- our insurance is dening the payment and holding us responsible because he is non preferred. How do we go about solving this? It isn't like we had a choice on Drs. We took. The one provided by our covered hospital. Any advice would be appreciated. Btw- tried to call tonight when we received the denial letter but they were closed.

 

I used to work for an insurance company years ago and this cropped up a bit, especially with emergency procedures.  I would call and ask for what the coverage is for doctors in an emergency situation.  And if you have to, appeal the claim.  And in the appeal, tell them everything...something I used to tell our customers over the phone...tell me everything that happened because the more they know, the more likely the claim decision can be overturned.  Usually you can do appeals over the phone.  
I hope that will help and the insurance will cover the surgeon, you'd think they'd understand in an emergency, you get who you get and they'd cover it...but it gets murky once they get to the doctors who are not under contract with them.
Another thing to look at the surgeon might be affiliated with a group that participates with the insurance, even if the surgeon himself doesn't.  Sometimes the doctor's office has to rebill under a group name rather than the individual doctor themselves.  
Good luck and I hope it gets straightened out.
I am glad your husband is doing better. 

 

How's you DH doing? What a frustrating situation. Good Luck with getting this resolved.  :hug:

 

I believe they have to cover the surgeon IF they cover the hospital stay.  Appeal the claim - it was an emergency situation (life or death).  Its not like it was elective surgery.  

 

Thanks for the input. Dh is going to call the insurance today and talk to someone. We have not recieved any bill from the surgeon yet- but the insurance EOC came saying that we would be responsible for $5100.00, and the surgeon assistant bill would be an additional $4100.
DH is doing great and returned to work last week. He still hurts a bit, but over all has had a great recovery!

 

Appeal.  However each time I appealed I finally ended up contacting my HR (insurance via my work) and the HR person put me in touch with our brokers.  Its worked 4 times for me including the $66,000 dollar NICU doctor bill because the NICU doctor's were not covered by our insurance.  However trust me when I say it can be a very long process.  It took over 3 years for the insurance to pay ALL the NICU doctor bills.  I had to keep resubmitting with the letter I had stating they would pay in full.  I would fax or mail or both.  Call to make sure they got it.  Call again to check on it.  And they won't let you talk to anyone who is actually helpful with the process like the appeals department.  For each and every day they were seen by a NICU doctor.  It was after their 3rd birthday that I finally got the last one paid off by insurance.  I also kept in contact with the doctor's group so they were aware I was appealing so it was never sent to collection.  The other times it was not so painful as it was usually just a one time bill of some sort.
 
Good luck. 

 

Like others said, appeal.  Also, your plan probably has an "out of pocket maximum".  I think our is 3,000 per person.  So you might not be responsible for anything above that.  My DH had major back surgery in December 2013.  The bills we got were CRAZY but once it all hit the max, we didn't have to pay anymore.

 

Funny thing is that we do have a max out for individual /family-7,000. The two claims from surgeon and surgeon assistant plus other puts us over 11,000. Bonus - his insurance renews at new year!! So the surgery was 12/31. All follow up is falling into a new deductible.
We could be responsible for up to 7000 in both 2014 and 2015. dh wasn't able to call today- he hols the family plan so I'm not sure that they would talk with me??

 

I'm on my DH's family plan and have never had issues with them talking to me.  I think as long as you are listed on the plan and can give identifying information, they should tell you.  You may also be able to look up stuff in the online system about deductibles, etc.

 

 
Same here.  The only thing I cannot do under my DH's plan is call about specific claims that are for him.  He has to do that, they are not allowed to speak to me (DH could send a letter in authorizing them to do so but he has not had any major medical claims that he's needed to do that) but I can call about coverage and anything and everything regarding me and the kids.  Your DH's insurance might be different and allow you to discuss his claims but in the case they do not, he can always get a fax number and fax a letter authorizing them to speak to you.