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Man frustrated when Insurance company snafu leaves him with $300 copay
** This article is a work of nonfiction based on actual events as shared with me by a friend who experienced them firsthand; used with permission. **
On a recent outing to take her daughter to a doctor’s appointment, my friend had to wait in the lobby while her daughter had some labs done. While waiting, she couldn’t help but overhear a gentleman on the phone at the reception desk for day surgery.
The receptionist had told the man his copay was $300. The man didn’t think this was correct, so he told the receptionist to call his insurance company and find out why. Upon reaching his insurance company, the man was informed that the insurance company hadn’t approved his surgery.
The man then spoke to the receptionist, who assured him they wouldn’t have ever scheduled his day surgery if his insurance company hadn’t approved it. The receptionist encouraged the man to go ahead and check in for his surgery and have it done that day.
The man was referred to scheduling, and scheduling reassured him that his insurance company had approved the surgery. Did he want her to check him in? The man said, ‘no,’ he would call his insurance company back.
Upon calling his insurance company, he asked to be transferred to a supervisor. The supervisor reviewed his account and assured him that he hadn’t been approved for surgery and offered to begin the process of approval; however, this process could take up to three business days, so she advised him to reschedule his surgery.
The man again spoke with scheduling to reschedule his surgery, and scheduling again reassured him that his insurance had approved it, so he asked to see the approval notes. Scheduling couldn’t produce the approval notice, so the man asked to reschedule the surgery.
By now, it had been almost an hour, and this poor man had been on the phone at the front desk the entire time, attempting to get things squared away with his insurance. Had he not questioned the $300 copay, he might have been stuck paying for the entire surgical procedure.
It is important to double-check that your insurance covers your surgical procedure. While it was frustrating to spend over an hour on the phone to find out what was happening, ensuring that the surgery was covered was essential. What do you think? Should the man have gone ahead with the surgery and possibly had to argue all of this after the fact?
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