Outpatient Procedure Claim Denied
Pretty irritated by this. We have Anthem Alliance EPO meaning we get a higher discount by using in-network providers but nothing is covered by using out-of-network providers (outside of emergencies and urgent care). My partner had an outpatient procedure scheduled, they were called by the physician's office and told it would cost $500 and was asked to pay upfront. A little strange but fine we paid. After the procedure that required mod anesthesia only, my partner was called and asked to pay their bill of $300. On asking, the biller said they never received the initial $500 payment even though it was charged to our credit card. Next, we look at our insurance app and it says our claims for the procedure were denied to the tune of >$4000. It says the anesthesiologist was out-of-network along with the surgery center. The anesthesiologist, sure I understand (I hate it but whatever). The center however was a facility within the same hospital system our insurance is part of!!! For example, if the doctor worked for Nike Health, the building it was done in was Nike Outpatient Surgery. Wtf!?
Going to appeal both the claims since we were initially misled but any tips on how to combat this egregious denial? Anyone had it overturned? Thanks in advance.
submitted by /u/Candid_Lie9249
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