On April 27, 2009, and June 3, 2009, I had two related outpatient surgeries. I had jumped through all the necessary hoops before scheduling the procedures including precertification, etc. The procedures totaled $57,474.55, which was far more than I expected, but I had insurance so I expected all would be fine. After all, that's why we pay monthly insurance premiums, isn't it?
Throughout the rest of 2009, the hospital and the insurance company negotiated a settlement of these two bills. The insurance company paid a fraction of the total cost, but I assumed that since they had paid something, the hospital would write off the rest.
In December, I received a phone call from the patient accounts representative at the hospital. "Elaine, what do you plan to do about your bill with us? You've got to begin paying on it." Really? I thought that's what insurance companies did.
I contacted the Baptist Mid-Missions insurance man. He informed me I would have to file an appeal. But my doctor had moved from her previous practice and I couldn't locate her new office. "Elaine, you'll have to have a letter of medical necessity from your doctor. You won't win this appeal without it."
After much prayer particularly by the ladies in my Bible study, the doctor was finally located in February 2010. She was amazed to learn that the procedures had not been paid.
I met with her, then with one of her associates, who walked me through the appeal process. I sent the appeal on March 9, 2010.
Five weeks later, when the insurance company had not even acknowledged receipt of my appeal materials, BMM's insurance man again contacted the insurance company. "They haven't received an appeal," he told me. It "had been lost."
I resubmitted the entire packet of information and sent it by registered mail, an expensive procedure.
Three weeks ago, the BMM insurance man called me. "Elaine, are you sitting down? The insurance company has reversed their decision. They've paid $5,000." But would the hospital accept $5,000 when the total bill was for almost $57,500?
Today, I received a copy of the Explanation of Benefits as seen above. The insurance company paid the entire amount. The EOB states, "The patient owes $0.00 to the hospital!"
Rejoice with me! God is good and I'm so thankful this evening. I'm grateful for this resolution to a problem that has been weighing heavily on me. I should rest well tonight!