Question about medical billing because I have no one to help me with this. Let me know if I should post this in another subreddit.

So I'm an autistic 27 year old with some mental health issues among other things like major depression, general anxiety, social anxiety, ADD (attention deficit disorder not hyperactive), an information processing delay, C-PTSD, and medical trauma.

In April I went to an oral surgeon who is in-network with my Medicare Advantage plan. He told me I needed Botox as a next step in treatment. I told him there was no way that my insurance would be okay with that without a prior-authorization. He agreed on making sure that the billing department takes care of that.

Fast forward a few weeks and I don't hear back from anyone at the oral surgeon place or medical billing. I look online at my insurance website and everything and I see no prior-authorization. I call the provider and they transfer me to billing and billing informs me that they forgot to put in the prior-authorization and they would do it now.

Should I have called it quits at that point as that is a red flag? Yes but this was the only place I knew of that was in-network with my insurance that could provide this service to me.

Well a week goes by and despite being told billing would call me back they never did reach out to me after my calling them. I look at my online account with insurance again and see that the prior-authorization was approved and it says I haven't heard back from the provider by a certain date I should call to get scheduled.

Nowhere did it say that I could have a copay and I should ask insurance about that (mind you I was on Medicaid for a year before getting Medicare so this is my first year dealing with this crap on my own). I just saw that it was supposedly covered by my insurance and jumped the gun so to speak.

When I called to get scheduled they did not check or notify me of a potential copay. I went and got the Botox and waited the 30-60 days for the bill thinking I wouldn't be charged anything. Now I am being told that there is a $350 copay and there is apparently nothing I can do about it except pay up.

I will be able to pay in the latter half of July but that is a sizeable amount of income for me as someone on government disability and with only a part-time (6hrs per week) barely above minimum wage job.

I spent all morning trying to dispute the bill just to realize there was no point in doing that and it was just a waste of my energy.

Now I'm concerned about the hospital bill I had in mid-June from when I had a scary adverse reaction to a medication and was admitted to the hospital for two to three days. The copays alone are above $2000.

I'm just so done with this crap. But my question is: is it my responsibility to figure out the copay or should I have been notified of it prior to my Botox appointment?

submitted by /u/Ok_Confection2588
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