Lost my chance at surgery because biller didn’t believe I could have Medicaid as secondary insurance

I'm a bit new to insurance, so I'm not really sure how to deal with this situation.

I have both third-party insurance and straight Medicaid. A couple days ago, my surgery was cancelled because my primary insurance denied coverage. I decided to file an appeal, but I didn't realize until yesterday that apparently, my surgery could've been covered if the billing department had submitted a pre-authorization to Medicaid as secondary insurance. I called up Medicaid and they confirmed that as long as medical necessity was deemed, they would cover the surgery even if primary had denied coverage (although they suggested a pre-auth be submitted).

The issue is that the biller for my surgeon's department doesn't believe that I can have straight Medicaid in NY while having third-party insurance. I know this is incorrect because I've called Medicaid Choice, Medicaid Helpline, HRA (who gave me Medicaid), the Department of Social Services, and my third-party health insurance all of whom told me I could have Medicaid as secondary insurance and coordination of benefits was sorted out. On top of this, different surgery departments within the same hospital have successfully billed me with straight Medicaid as secondary insurance.

I know my surgeon accepts Medicaid, so it's not an issue with the provider. It seems as though it's an issue with this one individual (who just so happens to be the senior billing coordinator). We've been going back and forth for weeks and she continues to claim I can't have straight Medicaid as secondary insurance. I am deeply frustrated by this, as I may now have to wait months – or even up to a year – to get surgery.

I plan to wait until the appeal is denied and then ask her to submit a prior authorization to Medicaid. If she refuses, I plan to ask to speak to a supervisor or potentially get a patient representative from the hospital to help me. I've also been wondering about submitting a complaint, but I don't want this to negatively impact my surgeon at all (as she's a wonderful, incredible individual and this isn't an issue with her as much as it is with her billing department).

I'm wondering if anyone else has any advice as to how to go about this situation? I really don't want to be a Karen, but this could be the difference between me getting surgery within months, or having to see an entirely different surgeon (in which it could be an entire year or two). Not to mention, I should've had this surgery 4 days ago, if the biller was competent.

Does anyone have any advice as to how to go about the situation?

submitted by /u/upset_larynx
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