I was not told surgery would not be covered under plan.

[dormonid]

California

To be brief to the point:

I was not told, either by the Healthcare Provider (Ucla Medical Center) and my Health Insurance Company (HTH Worldwide Insurance Services) that the surgery I had to have wasn't going to be paid by the Insurance Company.

I was actually told by (phone call) Ucla that the surgery was approved and that I had to pay a $50.00 co-pay due before the surgery.

The surgery happened and I started getting the bills.

My attempts to contact the doctor were not successful at all, since he never, ever tried to contact me. I sent him a registered letter explaining the situation, but he never got back to me.

Ucla was never helpful in this case and the person that called me and told me that the surgery was approved, vanished and does not work there anymore.

Finally I contacted my Insurance Company to try to understand how ucla told me that they would pay for something that they knew they would not. I got a letter from the company that says that they advised Ucla that the surgery would not be covered.

Basically Ucla knew from the beggining that they would not pay for that, but they never told me anything. They even took my co-payment, making me think that everything was ok.

My name is already in two collections agencies. I know I should have taken care of this earlier, but I would appreciate any ideas and thoughts about the case and what should I do about it. I live in the Los Angeles area and want to try to save my credit that was good until now.

Thanks,

M.

 

[creditchaos]

It is your responsibility to find out if any procedure is covered by your insurance carrier. Neither the hospital or the doctor is under any obligation to obtain and give you this information.
Whenever you speak to anyone by phone make sure to get it in writing. Otherwise it's your word against theirs and as you said the employee you spoke with no longer works there.
Customer service reps are given little training and if you happen to speak to one who is new you may get the wrong information.

 

[dakoto70]

if

the dr.s office had to get pre-authorization for the insurance company BEFORE they could preform the surgery than the office should have something in writting. Usually for something like a surgery the it needs to be authorized and with my insurance I have to call and get everything authorized first. Dr wants me to have something he has to call insurance co first and ask them and than go by what they say. Maybe if you can get the iffice to actually talk to you, you can find out if they still have the authorization on file???

Just me .02 worth

 

[creditchaos]

Good point Dakoto70. It is unusual for a doctor/hospital to not obtain preauthorization prior to performing a procedure. However, people screw up. And the bottom line is we are responsible to know what our insurance covers.