Q: My husband had back surgery 1 year ago. Our insurance gave authorization but now have denied the claim. We have 67K bill
My husband has double insurance coverage. 1 policy through his work (Grossmont Union High School district) and 1 policy through my work (San Diego Unified School District). He went through my policy and was originally given authorization for the back surgery. Now the insurance company is sending us a bill for $67,000. What should we do?
A: A California attorney could advise best, but your question remains open for two weeks. One option is to reach out to attorneys who handle health care claims. First, try to compile a complete file on the denial and its supporting documentation, such as EOBs. Also put together all the documentation you have on the pre-authorization. If medical necessity is any part of the basis of the denial, obtain copies of peer reviews or other medical opinions on which the denial is based. Two weeks have already gone by - review the small fine print on the back of the denials for timetables for appeals, filing suit, arbitration, or other options. Given the amount at stake, the investment in consulting with an experienced attorney here could be worthwhile. Good luck
Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.
The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.
Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.
