insurance denied claim 4mo after surgery – now i’m hit with the bill 1yr later

So last year I had a surgery done where my insurance (Untied HealthCare) covered most of it, I just needed to pay my $3k out of pocket maximum on it. I started making and going to appointments for it in March, got the prior authorization in May, and had surgery in June. But, turns out my insurance retroactively denied the claim in October- it looks like this was due to 'lacking documentation' although I'm not sure what.

I didn't find out about any of this until this weekend, where my hospital sent me a random $3k bill, looking at my EOB- insurance is denying coverage for the whole surgery, but that conflicts with hospital documentation which says they covered it except for this $3k amount.

I of course plan on calling insurance ASAP to try and figure it out, I guess what I'm asking is:

at this point this is way past the appeal stage, as I had no clue this was even happening, should I still appeal? hospital is only billing me for $3k, insurance is billing me for the full cost of the surgery ($34k), am I going have to be liable for that $34k if my appeal is denied? is this something that's typically resolved by just having my doctor send over necessary information? if i don't pay the bill while the claim is being appealed, what happens if it's sent to collections and then later appealed?

i know not everyone will have answers, but I can't call today and want to get some insight on what's happening and what i should expect

submitted by /u/KishCore
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