Suggestions for an unexpected $8k surgery bill almost a year later!
When my daughter was 9 she had to get braces. At 12 they established she’d eventually need jaw surgery. We saw a surgeon then who said we had to wait until she stopped growing. At 17 her orthodontist referred us for an updated evaluation and it was determined she could have it done. Prior to her surgery we had to have a sleep study which we had to get a PA for. We had to have a PA for the surgeon and consults, etc. Her surgery was scheduled for August 2023 (when she was 18) but the day before the surgery we found out her teeth weren’t spaced properly for where they were breaking her jaw. We were upset since the hospital knew we had hit our deductibles and wanted to get the surgery done. Her teeth moved enough to sneak in the surgery 12/16/23. Again, the hospital knew we were pushing this because we hit our deductibles, they called us w/ a last minute opening! They never gave me an estimate, and they only told me I owed $20/visit. I assumed all was good because I hit my deductibles.
Jump ahead to Feb 2024, my daughter gets a bill for $4k. I called the University of Michigan (where she had it done) and they told me I needed to contact BCN. I contacted BCN (which is all off shore and barely can understand). They agree I hit my deductible and coinsurance, and it should have been covered. They told me they would have someone look into it and get back to me. They didn’t. I called several more times, asked to speak to someone in the US, etc. Got no where. I looked back up my insurance policy and then discovered I had an addendum to my policy and something listed as “orthognathic surgery” was listed as an exemption. So I googled and saw that “orthognathic surgery” is the big word for “jaw surgery”. Mind you her PA’s all listed maxillofacial surgery and even the PA for the surgery says nothing about “orthognathic surgery”. At that point I filed for financial assistance. I am a single mother/teacher. Her dad stopped supporting her. And the bill was technically in my 18yos name. If we were told ahead of time the surgery was $8k, we would not have done it. I would have changed plans I had, etc. In April we got a statement showing “charity write-off”, so we thought we got approve for assistance.
Today I got a bill for $4k and flipped out. I called University of Michigan again. They said my insurance refused to pay the bill since it was “dental surgery”. I explained this wasn’t “dental”. Her jaw was broken, etc. I then said furthermore in April her account listed that the bill was paid as a charity write-off. The biller looked into it and said that was a “mistake” then said “charity write-off” is the code they apply before sending a bill to collections and that I actually owe $8k! And she said I should have gotten a letter in March about going to collections, I didn’t. At that point I lost my shit! I said I was never given an estimate for an $8k out of pocket surgery. The biller said I should have an estimate in my account, when she saw there wasn’t one she backtracked and said it was on me to request an estimate. Again, this is the University of Michigan Children’s Hospital! I am now retired, and do not have $8k for a bill we were not expecting and my 19yo (who has been in and out of mental health programs) certainly does not have the money! I told her again, we applied for help and never heard back. Since her dad can legally claim her on his taxes I need his tax return. He doesn’t support her at all. He stopped at 17. I have no way of forcing him to give his return. She said I can’t get further in the assistance process w/o the tax return. We did hash out the new $4k bill is from her wisdom teeth. My medical is claiming they don’t pay for wisdom teeth. I’m sure my dental is going to want to cover the cost of wisdom teeth removal in a children’s hospital OR! They are going to try billing my dental. But I think my max dental coverage for a year is $2k.
The biller said if I had a PA I would have gotten an estimate. She said she didn’t see any PAs. Well I have all 5 of them in my insurance account. When I went to the hospitals “estimator” online, jaw surgery isn’t listed. When I put in the CPT code from the PA, nothing shows up either. So there was even no way for me to get an estimate on their website! So again, I would think the office should have known to give an estimate. Furthermore, the wisdom teeth apparently aren’t covered at all and they just NOW discovered that, nearly 1 year later! When hospitals run PAs don’t they also make sure shit is covered by the insurance? Sure, don’t give me the cost, but shouldn’t they have figured out back in AUGUST 2023 that her wisdom teeth weren’t covered?
My mom worked in hospital medical billing her entire life. She’s going to take this on. But is there any recourse we have? Is there anything we can do or should do? My mom had me request all the billing invoices to insurance, etc. The addendum states that there is a 20% copay on orthognathic surgery. My mom worked for Henry Ford and they always gave estimates. I have friends who work at other university hospitals and they give estimates! At this point if we can’t get this bill covered or decreased significantly my daughter will be going to collections. Seeing as she has a 820 credit score I really don’t want to do that to her, but none of us can afford this. I hit my deductibles and coinsurance in March this year due to her mental health. And in July when I retired I had to start new insurance with new deductibles we’re 1/2 way to meeting. Part of the reason I retired was that I couldn’t juggle her health and a job!
HELP US!
