Was CC’ed on letter from my insurance to my provider saying their final appeal was denied. Unsure how it affects me.

I'm in NY, for context. I've had multiple endoscopies to figure out a food allergen, and with this specific doctor I've had four (May 2023, September 2023, November 2023, June 2024). All of them have been at an out-patient hospital. All but the November one have also been approved by my insurance and I was just issued a $500 copay (ridiculous but whatever)

Over the last few months I've been CC'ed by my insurance on their letters to the hospital. Basically, the hospital incorrectly coded the authorization to my insurance and so it was denied – meaning there was no prior authorization for my November procedure.

My EOB said that the patient can't be billed for the service either, but I'm not sure how my insurance can stop the provider from billing me.

The latest was today when I received a notice of final appeal where my insurance denied the most recent appeal from the hospital, and claim they won't process any more appeals related to the matter.

So I'm a bit lost on if I'm going to get the full bill or not, which was for $13,000.

I know the EoB says I'm not eligible but then the letter also has a section for members to appeal the decision with external parties. Im hoping it's just standard form but I don't know if this means I should be prepared to appeal since I'll get a bill? Just confused.

Additionally the final appeal said that it wasn't medically necessary for my procedure to be in a hospital…yet they covered the three previous claims at the same hospital. So also confused on that.

I just don't want to find a $13,000 bill in the mail.

submitted by /u/riccarjo
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