[yorkiefan_]

Arggh this has me so angry. My mom has breast cancer and her stupid insurance company denied coverage for her biopsy a couple of months agho because she didn't call them first even though she got the reference from her primary care nurse. So fine, she paid the $1000 for the biopsy with the knowledge that she better call the insurance company for every single thing to get pre-authorization. So last month she got surgery to remove the lump and some lymph nodes and that was covered fine, no denials showed up on the benefits summary for the surgeon, anesthesia, hospital, etc. Her surgeon assured her she was pre-approved for everything and when she called insurance a couple of days before the surgery to double check they gave her the green light.

A couple of days ago she got her benefits statement for the insurance and it said she was denied on the labwork to test her lymph nodes and margins for the cancer (thankfully the lymph nodes and margins were all clear and the tumor was less than 1cm, so it was about as good of news as we could get there). So she owes $1100 on that now to the lab that did it. She was assured by both the surgeon and insurance that everything was being done in network and the hospital is in network. I talked to the front office for the surgeon and they say she should be 100% covered, I talked to insurance and they said the hospital sent her tumor/margins/lymph nodes to an out of network lab.

What the hell? This is ridiculous, this insurance is pretty expensive and now my mom is getting hit with an $1100 extra charge after she did her due diligence with both the surgeon and insurance? Does anyone have any idea how to appeal this? The insurance paid the lab like $300 but the lab charged $1400. This is making me so angry that my mom pays through the nose for insurance and the moment she goes to collect on it she gets critical procedures denied.