I checked into a hospital for an appendicitis. After 36 hours, I asked the doctor if it was OK to spend the next few days recovering at my sisters house a few miles away rather than running up a huge bill just lying around the hospital. Little did I know that the insurance company now considered this an outpatient surgery and an elective surgery since I didn’t stay in the hospital for the “full time”. What a way to get out of paying. The hospital, thankfully, came down to $18,000 instead of the full $27,000 they were wanting to charge me. I’ve paid my doctor/surgeon, radiologist, anesthetist and a few other bills that have been received. Also, any advice would be appreciated. Maybe I’ve missed something that could send this back to the insurance company.
That sounds like a cop-out by the insurer. I would suggest you appeal it and provide an explanation. Appendicitis on an emergency or urgent basis would not be considered elective by any stretch of the imagination. You only have so many days to make the appeal, so gives this your priority attention. Elective is pre-planned in advance. Appendicitis is generally unplanned.
When in doubt, read your health insurance policy to be sure.
This is upsetting and frustrating. You are trying to be a good consumer, manage healthcare expenses, and the insurance company does this. I am never surprised by the excuses given by payers to reduce their liability. Please seek professional assistance to get this addressed quickly. You only have a short window of time to appeal and your primary care doctor/surgeon should provide assistance to you in preparing a formal appeal. If the policy is through an employer, go to H.R. and find out who in the organization can assist you with the employer sponsored benefits. Insurance companies may also respond to pressure from the entities that pay the premiums. Either way I would not let it go.
Feel free to contact me if you need assistance.
There was a very famous article written called the $55,000 appendectomy that showed how much the prices can range for this procedure:
So, take heart—the large medical bills for appendectomies has been noted!
When you call to talk to the business office of the hospital, use Healthcare Bluebook’s estimate as your baseline (for our Texas Medical Center here in Houston, it showed a little over $10,000 for the entire procedure):
And I would also call my insurance company to let them know that I am their best customer ever! (Saving them money!)
Unfortunately, the lower level people will just go by the book/rules and you might not be able to make your case for common sense—it’s the upper level management/supervisors that can waive the rules, especially for such a conscientious consumer!
Good luck! I hope you are able to reason with everyone involved in your billing and hopefully, get the entire procedure covered!
I would most definitely appeal this with your insurance company!
You will want to obtain the medical records to see if the doctor admitted you.
I’m questioning what type of authorization the hospital obtained for the surgery. Normally, this would be inpatient status. Did the hospital have you sign out AMA? Did the hospital call insurance company back and obtain authorization for outpatient surgery prior to surgery? Only the medical records would give you this information.
I would have to recommend getting a medical bill advocate to help you with this bill since it’s such a large bill. The 18K that the hospital is billing you is still too much!
A medical bill advocate can audit the medical records for correct coding, compliance and pricing and then negotiate any out of pocket expenses that you might be responsible for.
Most medical bill advocates can go back 2 years sometimes 3 years if the account is still owed, reviewing your claims for errors. They normally charge 25%-35% of what they save you and if they can’t save you money their services are free. Medical bill advocates can normally save you hundreds if not thousands on medical bills.
If you need assistance please reach out!
Cheryl Welch, MBA
Hudson Valley Medical Bill Advocates
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