$44k surgery, UMR giving me the run around. In desperate need of advice.

I’m in SC. I had an emergency surgery in June to remove my gallbladder. When the hospital sent the bill to UMR, they did not send my clinical documents, so UMR denied the claim as not being medically necessary on 7/5. They state that they requested the records 3 times prior to denial. The hospital states they sent them over in September and filed an appeal. I saw yesterday that the hospital has filed another claim on 10/24 for the same dates of service, same amount which was also denied because there was already an appeal for the first denied claim.

Every time I speak to someone, I’m told it’s being escalated and/or someone will reach out. I’ve been calling them and the hospital billing department weekly since July to try to get this sorted. I’ve documented every conversation and the info I was given, which is all over the place and incredibly inconsistent. They’ve sent me to an Appeals Department voicemail where I’ve left messages and received no follow up. When I contact, I’m told to give it more time and that there is no time frame in which they are required to respond. How is this legal?

I don’t know if this matters, but my spouse changed jobs/insurance shortly after the surgery, so I no longer have UMR coverage. I WAS covered during the period in which I had the operation.

I don’t know what to do anymore. I cannot pay this bill and I shouldn’t have to since this was denied due to the incompetence of the hospital’s billing department. What are my rights here? Do I have any?

submitted by /u/Willing-Nectarine-68
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