Surgeon’s Office Filed Pre-approval Late/Incorrectly

I have a surgery scheduled for 10 days from now, the appointment was made several months ago. Yesterday I got a call from my doctor’s assistant saying that there was a problem with my insurance. Today on a phone call, she revealed that the hospital normally requires prior authorization at least two weeks before surgery and that she had also filed for the wrong billing code, despite two conversations between us in which I clarified which surgery I would need.

Since she only discovered the problem (unrelated to the incorrect billing code) yesterday, it seems to me that she did not file with my insurance with an appropriate amount of time for the authorization process. She said that she can delay their financial office until monday waiting for the approval, but this won’t be enough time for my insurance to go over a totally new claim.

This is a surgery that I’ve been waiting nearly a year for. It is medically necessary in a few different ways, and every day I go without it is psychologically and physically painful. Now, it’s looking like the hospital is going to cancel the surgery.

Is there any way for me to get recourse for this? Ideally, I will be able to have their deadline for insurance pre-authorization delayed so that my insurance has time to re-process the new claim.

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