Healthcare Denied $18,000 claim.

TLDR: Just saw that my insurance denied my claim of over 18,000 USD and I’m freaking out!

Sorry if this post is everywhere and isn’t structured well. I’m on mobile and feeling really stress right now.

(This is going to be a long post)

So at the beginning of this year, I started having health issues and went to see my PCP, he referred me to see a hematologist as he believed I was severely anemic. Early February I was finally able to go see the hematologist and (getting a bunch of lab works done prior) he immediately told me to admit myself in to the hospital as I needed a blood transfusion due to my hemoglobin levels been at a 6.

Context: After my PCP told me that I need to see a hematologist, I knew that due to my location no hematologist in my area was covered under my insurance, so I called them and they said the closest one near me was an hour and a half away. Due to how serious everything was I decided I would make the drive.

Back to the story: Once I realized I would have to be admitted ASAP, I made sure to check that the emergency department I would be going to was in network. And on the website of the insurance company it was, I even spoke to the nurse that was transporting me and she said I would be in Network because most of the doctors in the hospital took my insurance.

Anyways, I was admitted into the hospital as an outpatient and was given 2 units of blood and an iron transfusion. I was very anxious the whole time I was there because of the cost of everything but family around me were saying I shouldn’t think of it at the moment.

The past 2-3 weeks I’ve been going to check my claim and they were all accepted except for the biggest one ($18,000). I called the claims department and asked why it says it was denied and they said something along the line that they have a contract with the hospital, and that the cost exceeds their contract (I’m paraphrasing as I don’t remember exactly what she said as this was about 2.5 weeks ago). Overall of what she says is that I need to wait for the EOB and that I should call the hospital and talk to them, that as of then I will be responsible for the full amount!

Since my last phone call with the claims dept. and the hospital (who says they will look into it) I have not heard anything and the EOB was released as of this past Friday.

I guess I just wanted some advice and if there is a way to go about this. Do I call the hospital? What do I even say to them? What do I say to the claims dept. when I call them this week? Is there a way for them to actually cover part of this claim and remove the denial?

Anything would help. Thank you!!