Insurance won’t cover air ambulatory bill that was out of network

Back in Oct 2021, I had open heart surgery at Cleveland Clinic (I live in VA). All was well and went home about a week later. 5 months post surgery, I had an infection and was admitted to the ER at my local home hospital. For the next week, I was under twilight anesthesia (I guess that’s what it’s called). I was basically awake sometimes but have zero recollection.

During this time, I was re-opened and parts of my sternum were removed as the surgeons believed the infection had reached the sternum. Days later, the surgeon said he thought the infection had reached the aorta and since he wasnt the one who performed my initial open heart surgery, he wasn’t comfortable moving forward. We were told we needed to go back to Cleveland. The hospital set up air ambulatory services to transfer me back to Cleveland on thanksgiving day.

Since it was thanksgiving, the insurance company was closed and we weren’t able to get the charges pre-approved. The ambulatory company told my husband the only option was to self-pay the full $28k, which he did, as he was told this was a life or death matter.

In terms of health, all ended well and I am healthy again. However, my I insurance is only agreeing to pay $9k, as the air ambulatory company chosen (by the hospital) ended up being out of network.

A month later, the no surprises act was put in effect, which I believe would have probably covered our issues but we were a month shy.

I’m at a loss of what to do. I’ve had the claim resubmitted to my insurance company and they said the most they will pay is the $9k. Where do I go from here?

submitted by /u/Live-Judge-1410
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