Hospital told my wife's procedure was authorized, now it’s in collections and nobody can explain the bill
I’m really hoping someone here has dealt with something like this because I honestly have no idea what I’m supposed to do.
Last summer, my wife's ENT told her she needed 4 procedures. One was in-office and the other 3 were going to be done at the hospital. A few months later, they started working on scheduling and prior auth. One of the procedures, involving the Eustachian tube, was apparently having trouble getting authorized. We told them very clearly that if insurance doesn’t authorize it, we're not doing it. They told us they were working on it and would cancel if they couldn’t get it approved.
A few months later, they told us everything was authorized. I asked multiple times because I had already warned them that we wouldn't do the procedure if it wasn't approved. The hospital was very weird at the beginning, asking us if we would still do it if unapproved. Like, who would? They said yes multiple times, everything was approved, so we carried on.
Before the hospital visit, the hospital told us we had to pay a little over $2,000 up front. They showed us the breakdown and it included her deductible (we each have a $600 one), so we paid it. Then the bills started showing up later.
The earlier in-office procedure was billed separately, came in the mail later, and suddenly I had another bill for about $900, including around $600 toward my deductible. That made no sense because we had already paid the hospital over $2,000 and the hospital's own estimate showed her deductible being included.
We've spent the last 6+ months going back and forth with hospital billing and Accolade (which we have to use for our insurance). Nobody will give us a straight answer.
Eventually, Accolade told us that the Eustachian tube procedure was never actually authorized. Apparently that’s why we're now responsible for the full charge, which looks like it could be tens of thousands of dollars. But the hospital told me multiple times that it was authorized, and I specifically told them I would not do it without authorization.
And somehow!!! (this is the even more ridiculous part) the other numbers still don't make sense either. I am a numbers guy, and none of them line up. It doesn't matter how many times i try getting on the phone with their billing department and/or Accolade, it all ends in word salad, non-answers.
Last week we sent the insurance a written dispute after Accolade told us to do that. Accolade said they would contact the hospital/provider for letters of medical necessity. Meanwhile the insurance responded saying they won't even review the dispute of the insurance claim without a letter of medical necessity. When we asked Accolade for an update on "where is it?" they are suddenly giving us the same word salad that the hospital did. I can't believe it.
I have no idea what that is supposed to mean. Isn't that something the doctor/hospital sends to the insurance company? I've never been given one. Now, to make things even worse, we got a letter today saying the debt has gone to collections. We haven't ignored this debt! We've been fighting with the hospital and insurance for months trying to get someone to explain what the hell happened.
So what do we actually do now?
Do we need to get the full claim history and all the EOBs? Demand the hospital's prior auth records? Ask for proof of what was submitted and approved? File an insurance appeal? Dispute it with the collection agency? Talk to a lawyer?
Does the fact that the hospital repeatedly told us the procedure was authorized, after I explicitly, multiple times, said I wouldn't do it otherwise, matter here? I mean who even in their right mind would do a unapproved procedure?
I'm completely lost. Any advice from someone who's dealt with hospital billing/prior auth/insurance appeals would be hugely appreciated. There is a clock ticking on both this debt collection notice and insurance claim appeal and we just feel so defeated. I hate this system.
