Insurance payment for surgery includes benefit for post-op visits but office is still charging. Do I have to pay?

I had surgery late last year and had to pay a significant amount out of pocket, but I was fortunate in that I at least met my deductible. I then had two follow-up visits with my doctor/surgeon prior to the end of the year which I assumed should be 80% covered as per my plan’s policy after meeting my deductible.

Unfortunately, my insurance has rejected both claims with the following explanation: “Your plan pays for charges we find to be reasonable and appropriate. The payment we already made for the surgery includes the benefit for the pre-operative, post-operative and same day visits. It also includes the benefit for related procedures and services. You do not owe this amount.”

So insurance says that I don’t owe anything, but I’m still getting bills from the doctor’s office for each visit with a combined total near $2,000. Do I have to pay? I’m assuming that I probably signed forms at the office agreeing to pay any charges, so I’m not sure I can get out of it. It seems like my insurance is basically shirking any responsibility even after I’ve paid thousands into my deductible.

Does anyone have any advice regarding how I might proceed? I would like to follow up with my doctor’s office and ask them to cancel the charge as per my insurance, but I don’t know if I actually have any legal leverage here.

See also  No increase in county workers' health insurance contribution - El Dorado News-Times