KarenK
Well-known member
My ins. denied coverage. CC did an urgent peer-to-peer appeal. CC called when the urgent appeal was to be completed, said it was denied and ins. co. won’t respond again until 11/2, surgery is 10/24. So we’re in the 2nd level of appeals. CC said my case was submitted to the powers that be and they would go ahead and do surgery and deal with the ins. on the backend. CC also said that they were going to except what the ins. pays and I only need to pay $275 and I wouldn’t be liable for anything else. Said they were a non-profit and this is what we do to assist when needed.
It didn’t seem right, I was very doubtful. I talked to the drs. office the next day about the surgery being off. The assistant had the managing NP call stating the same thing about the limited charges to me.
So thing are moving along and I start to hear little tidbits of info. from various people that conflict with what I’ve been told regarding coverage and that the urgent appeal was never filed.
I’m supposed to fly to CC this Sat. Yesterday I received 14 requests for info for pre-op tests and these requests include payments I’m to make before testing. There’s also a doc. to sign that says I will be 100% liable if ins. denies coverage or any and all amounts that ins. doesn’t pay. This was not what I was told.
I just received a partial estimate for surgery, $278,840, that doesn’t include the anesthesiologist, any other drs. or personal involved.
I asked for additional estimates. I received a partial again of $21,000 for some of the pre-op. On the hospital stay I was told, “we don’t do estimates on that because we don’t know what the charges will be”. Huh, CC doesn’t know how much they charge for rooms in their own hospitals? I did see on their site that ICU and cardiac rooms are $6,200 a day. 5 days would be another $32,000 plus I would assume much greater charges for all that goes along with that.
Today 2 different people read to me the original agreement that I mentioned at the start. When I asked for a copy, one kept saying no, and the other said it was illegal! When did it become illegal to document the terms of an agreement between parties?!
Known charges are $330,000, my guesstimate is charges may be $450,000. (10 yrs ago I had a craniotomy at the Mayo Clinic for a leaking brain aneurysm that was $100,000. That’s a 35% increase every year to get to $450,000.)
Kinda feels like bait and switch. So, at this late date I now have no protection if the ins. continues to deny coverage. The CC could decide not to proceed with challenging some or all of the denials. Then it all falls on me.
The CC didn’t follow through on the ins. appeal in the past… they may not in the future when they have another funding source…me. Lost my trust in the CC, I’m going to cancel my surgery.
It didn’t seem right, I was very doubtful. I talked to the drs. office the next day about the surgery being off. The assistant had the managing NP call stating the same thing about the limited charges to me.
So thing are moving along and I start to hear little tidbits of info. from various people that conflict with what I’ve been told regarding coverage and that the urgent appeal was never filed.
I’m supposed to fly to CC this Sat. Yesterday I received 14 requests for info for pre-op tests and these requests include payments I’m to make before testing. There’s also a doc. to sign that says I will be 100% liable if ins. denies coverage or any and all amounts that ins. doesn’t pay. This was not what I was told.
I just received a partial estimate for surgery, $278,840, that doesn’t include the anesthesiologist, any other drs. or personal involved.
I asked for additional estimates. I received a partial again of $21,000 for some of the pre-op. On the hospital stay I was told, “we don’t do estimates on that because we don’t know what the charges will be”. Huh, CC doesn’t know how much they charge for rooms in their own hospitals? I did see on their site that ICU and cardiac rooms are $6,200 a day. 5 days would be another $32,000 plus I would assume much greater charges for all that goes along with that.
Today 2 different people read to me the original agreement that I mentioned at the start. When I asked for a copy, one kept saying no, and the other said it was illegal! When did it become illegal to document the terms of an agreement between parties?!
Known charges are $330,000, my guesstimate is charges may be $450,000. (10 yrs ago I had a craniotomy at the Mayo Clinic for a leaking brain aneurysm that was $100,000. That’s a 35% increase every year to get to $450,000.)
Kinda feels like bait and switch. So, at this late date I now have no protection if the ins. continues to deny coverage. The CC could decide not to proceed with challenging some or all of the denials. Then it all falls on me.
The CC didn’t follow through on the ins. appeal in the past… they may not in the future when they have another funding source…me. Lost my trust in the CC, I’m going to cancel my surgery.
