Health, Wealth, and Happiness?

3.27.07

I have always heard the medical bill horror stories, and honestly, thought they were caused by people’s own negligence by not having insurance.

After getting my mail today, I may have to change my tune about that. I had two foot surgeries, one in 10.06 and the other one last month. The surgeries were totally successful. I traveled to California to have them done by Dr. Richard Moy in his Foothill Surgical Institute, which adjoins his office. I have Aetna insurance through my employer, and on paper, it is a really good plan.

I received a preauthorization approval letter from Aetna before the 1st surgery and later phoned Aetna to confirm that the 2nd surgery would be covered before having it done as well. I was told that there were no problems.

Fast forward to today, when I received a bill from Foothill Surgical Institute for a bit over $40,000 in my mailbox when I got home from work. I was flabbergasted. After calling Aetna, they contend that the fees for the surgical center are not covered since it is an outpatient surgical center and not a hospital, and they are unable to negotiate with it since it is out of network.

So…. I have called the billing office and heard nothing, and Dr. Moy’s office manager and heard nothing (although it was almost 5 in CA so I suppose it is to be expected). As much as I hate to do it, I think I am going to have to hire a lawyer and pursue this legally. Aetna was very unyielding when I spoke with them on the phone, despite the fact that I have a letter from them saying that the surgery is authorized (and the outpatient surgical center is COPIED on this letter.) Plus, I cannot believe that the doctor’s office has never handled any claims for Aetna before. He does hundreds of surgeries a year and I can’t possibly be the first one ever to use Aetna. There has to be a way in which this can be handled. But I am willing to force it to have the preauthorization honored if I have to.

I was despondent about this when I first got the bill this afternoon, but now I am ANGRY. More to come…