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Author Topic: Claim Denied - What!!??  (Read 2768 times)

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Ken B

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Claim Denied - What!!??
« on: October 12, 2014, 06:20:38 PM »
The surgeon bill got paid as well as a number of other items pre-surgery but the 80K bill from the hospital just listed as "denied" on the website. This includes the hospital stay, drugs, radiology, anesthesiology, the device itself, PT, OT etc. etc.

My original claim search on my benefits page indicated the resurfacing would be covered 100% after a 1K deductible. I received a letter from Anthem pre surgery saying I had given medical management the proper notification for the procedure and that the provider and facility are in my network.

So what gives with the "denied". I'm going to assume that this initial denial is related to them sorting the ins and outs of this large bill with regard to some possible co-pays for PT or something like that because anything else is just nuts.

Anyone else see an initial denial post on their account that got sorted out later?
RBHR 09/15/14 - Dr. Schmalzried


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Re: Claim Denied - What!!??
« Reply #1 on: October 13, 2014, 05:35:03 PM »
I would call the insurance company to see what's going on. Better than fretting about it until 'it sorts itself out'.
BioMet Left Hip Resurfacing, Dr. Gross, 07/2013

Ken B

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Re: Claim Denied - What!!??
« Reply #2 on: October 13, 2014, 06:32:09 PM »
I did  - it was a coordination of benefits issue - they just wanted to make sure I did not have multiple insurance sources which I don't. Should be OK.
RBHR 09/15/14 - Dr. Schmalzried


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