Surgeon refusing treatment until payment from insurer we no longer have.
My wife was diagnosed with breast cancer in early 2023. She went through chemo and radiation and decided to opt for breast reconstruction using natural tissue. To date, she’s had four surgeries: a partial mastectomy, a full mastectomy, a removal of a spacer due to infection and a breast reconstruction using fat from her abdomen. There is one remaining surgery which was scheduled for July this year. A week before this surgery, it was canceled because the surgeon had not been paid for the last surgery, the breast reconstruction, that took place in December 2023. At the time, we had Anthem as our insurance.
(In 2024, we switched to Blue Cross in order to keep my wife’s doctors, most especially, this plastic surgeon. So we no longer have Anthem.)
We’ve spent hours on the phone with the doctor’s office, the IPA (Providence Saint John’s Medical Management) and the doctor’s outsourced billing office and the stories we get are very mixed.
To me, this seems extremely unfair. We made sure our insurance covered our doctors. We paid our bills. Yet the surgeon refuses to proceed with the surgery despite being involved in three of the four operations so far. (Her office says she doesn’t work for free and we’re lucky she take insurance at all.)
I’m hoping for advice on how to approach this. Who next to call? What, if any, recourse do we have. Needless to say, this is very upsetting for my wife.
We live in Los Angeles and are both self-employed so we went through Covered California for insurance if that helps at all.
Thank you so much.
submitted by /u/waxybuildup
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