UnitedHealthcare Covering NOTHING for Female Sterilization

Hi All,

I got a bilateral salpingectomy as permanent birth control late May of this year. Prior to getting the procedure done, I confirmed with UnitedHealthcare that it was going to be covered at 100% as preventative care. I have reviewed my certificate of benefits and list of preventative care services and confirmed that the followup and consultation appointments should have been covered as preventative, too (I live in a state where there are laws that they have to be, and the certificate of benefits outlines this).

However…UnitedHealthcare is trying to charge me for ALL OF IT. They paid NOTHING for the consultation appointment, and it looks like they are paying very little for the sterilization procedure. The followup bill hasn’t come through yet.

I spoke to them and they said that the procedure and the other appointments “weren’t billed as preventative care” by the hospital. I have looked at the preventative care codes for my insurance (my employer’s HR department was able to get me these) and this seems to be the case. However, despite me escalating this to the hospital’s billing department, they are insisting that everything was billed correctly. I provided them with my doctor’s notes, with every bit of documentation I could, and they still are stating that the visits and the surgery were billed completely correctly. They are refusing to give me an explanation of how they decided to bill things the way they did. The closest I got was them saying my “medical history” was discussed when I consulted with the surgeon for my surgery, therefore it could not be billed as preventative care.

I really need help. I keep trying to reach my surgeon but no dice so far. I called Planned Parenthood and told them what was happening to me (they recommended me this doctor and hospital) and they seemed pretty alarmed. I don’t want to have to escalate to the law, but I’m scared I might have to. Oh, and I’m starting a PhD in August. It is June now.

Does anyone have any advice? I have documentation like everyone always says to get, but when I provide documents they are ignored. The hospital keeps just saying over and over “we’ve determined the services were billed correctly” with no further explanation. Then I call insurance and insurance states that if I want my services to be covered, I need to contact the billing department at the hospital.

Both hospital and insurance keep telling me to talk to the other party. Insurance keeps saying they covered services correctly according to the billing codes. The hospital keeps saying they billed the codes correctly. But they didn’t, and I can’t afford the medical bills they’re trying to force (illegally) on me.

It’s Advocate Aurora Health, if anyone is wondering.