Follow-Up Post-Surgery Charges

I have a friend who had an outpatient surgical procedure (ureteroscopy) to remove a kidney stone. (This was with Kaiser.). He was covered under his employer at the time of the procedure. About a month later, he changed employers and now has a different insurance.

After changing jobs, he got an unsolicited call from his Kaiser Urologist to see how he was doing. He told the Urologist, “I no longer have Kaiser.” Urologist said it was not a problem and was considered follow up from the surgical procedure. He answered a few questions, explained how he was doing fine. Call lasted 5 minutes at most.

Urologist (incorrectly) puts the visit notes as a Video Visit. Friend then gets a notice from his new insurance (Cigna) that the charges from Kaiser (for this follow up visit) were not covered as it was considered “out of network”.

My friend filed a grievance with Kaiser and they rejected it and said the charges (around $150) were appropriate and he was responsible for the charges. It seems totally ridiculous to me.

My questions: 1. My friend was fully covered by Kaiser at the time of the surgery. He never even let them know he changed jobs (since it was after the surgery) or now had different insurance. How can they justify trying to charge Cigna?

When I’ve had surgery with other insurance companies, even in person post-op follow ups were fully covered and I never even had a co-pay. This seems like a similar situation as it was about a month after his surgical procedure.

The doctor seems at fault here because he said it was a video visit (when it wasn’t) and my friend has the cell phone logs to prove it. Also, my friend was very clear he no longer had Kaiser and the doctor said “it was covered as post-op follow up”.

What should he do? File a complaint with the Department of Managed Care? Dealing with Kaiser is such a massive headache when something goes wrong.

submitted by /u/labboy70
[comments]