Omaha, NE asked in Health Care Law for Nebraska

Q: I had back surgery Nov. 30, 2018. My insurance company denied a portion of the fees stating it was experimental.

I was preapproved for the surgery, but surgeon used different technique and device than what was preapproved. Do I have grounds to fight this charge ($8,956)?

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1 Lawyer Answer
Julie Fowler
Julie Fowler
  • Omaha, NE
  • Licensed in Nebraska

A: There is often an administrative appeal procedure that you can make to your insurance company when a claim that you thought would be pre-approved and covered was denied. The hospital or facility also wants to get paid so they may be willing to assist with this appeal. Sometimes a good place to start is to reach out to the billing office of the hospital or facility to see if they can assist with appealing the insurance denying the charge. What is ultimately going to be covered under your policy depends on the specific terms of the insurance policy.

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