Post surgery hospital stay "prior authorization denied"
I recently had a "total knee replacement surgery." My insurer *did* pay for almost every aspect of the surgery except the hospital stay. Of course that's the largest bill, coming it at well over 5 figures. The bill is for room and board rather than medical care, lab tests, medications, etc. The peculiar bit is that the reason for denial is "prior authorization denied."
So I'm trying to establish if a hospital stay after knee replacement is typical, and if it's typically paid for by the insurance company. There were complications after surgery that extended my stay, but as far as I know the original stay was supposed to have been approved. Which brings up the question of whom is responsible for requesting said prior authorization. I have spoken briefly to my surgeon's office, but I wasn't clear on some of the details so the results of the conversation were inconclusive. I will talk to them (and my insurance company) tomorrow to get more details as I believe they (the surgeon or his staff) would typically be responsible for obtaining said authorization. If they are not usually responsible for that, please let me know.
How should I proceed here? Should I file an appeal? Should I have my surgeon file an appeal? I have not officially received a bill from the hospital yet (so far I've just seen the explanation of benefits from my insurer, with an estimated patient cost and the denial note.) Should I therefore wait to get an official bill from the hospital before appealing anything?