Procedure Covered by Insurance - Then We Were Billed Six Months Later

[pdm]

My question involves insurance law for the state of: PA

- Wife had surgery in the fall of 2010 - all was covered by health insurance - six months later we received a bill for $850 - I called hospital to ask about it and they said that they would look into it - Didn't hear back from them - - We recently received a collections letter for the $850 - - Called hospital told them that I had never heard back from them - - - I asked about the original service date and billing....

- Oct 28, 2010 - pre-op appointment - COVERED - $50 copay - PAID
- Nov 1, 2010 - surgery - COVERED
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- May 6, 2011 - Insurance company reverses coverage for the Oct 28 date of service - hospital bills us $850

Where do we go from here - can the insurance company change their mind six months after covering?
How could a pre-op appointment not be covered ?

[cbg]

In some circumstances yes, they can. But we don't have anywhere near enough information to say in this case.

A pre-op appointment can not be covered if that's what the policy says. Nowhere is there a law that says all pre-op appointments MUST be covered by health insurance. I haven't read your policy so I can't say if it should have been or not.

When you called the insurance company and asked them about this, what did they say?

[lealea1005]

Yes, the insurance company can reverse the decision under certain circumstances. The error was probably found during an internal audit. Could have been several reasons for their decision.

What is the reason given on the EOB you must have received from your insurance company?