Humana Denial - An approved authorization notification was needed from your provider. No action is needed from you.
My husband had a prior auth for surgery. Humana paid the surgeon. But they denied the claim from hospital. It’s $141k. We have not been billed from hospital yet. The surgeon told us before surgery it would be a 1-3 day stay in hospital and it ended up being 6 days because the social worker screwed up and didn’t get the equipment to our home for him to safely go home. Anyway, the title shows what is on every line of their denial - “An approved authorization notification was needed from your provider. No action is needed from you.” They list the $141k under Plan/Benefit Exclusions but if you look at the fine print of the claims receipt it says - Plan/Benefit Exclusions: Services not covered, which you may be responsible for paying to your provider. WTH? They do show $978.60 as our share. Those charges for the $978.60 are for services not covered by Medicare therefore we have to pay lines. I don’t mind paying $1k, I just don’t want to pay $141k.
I’m not sure whether to begin freaking out or not. Is this unusual? It’s never happened to us before. What should our next steps be?