Received Pre-Approval for Surgery – Claim Now Denied (Anthem)

I went through the process to get pre-approval for a surgical procedure earlier this year. I got the pre-approval letter and they called me and we went over the expected cost (I would have to pay my out of pocket maximum which I was fine with).

I had the procedure and now that the bills are rolling in, Anthem is selectively denying the claims and saying that this type of procedure isn't covered under my plan (they approved the operating room but not the doctor, they approved the medications but not the recovery room). I keep re-reading the pre-approval letter and it is very clear and it enumerates the procedure in detail. There is no fine print in the letter either with a caveat that they're actually not sure. Anthem just keeps repeating to me that the procedure 'isn't approved under the medical plan'. They also threatened me that if I keep challenging them they will 'audit' the other payments and retroactively deny those if they shouldn't have paid out on those claims.

The cost is tens of thousands of dollars which the surgeon and hospital now have billed me for saying I'm responsible if the insurance company doesn't pay.

Any advice?

submitted by /u/chewbaccasaux
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