Two years later, this $18,926 surgery claim is still in limbo is there a way out?

"Almost two years ago, I underwent emergency spinal surgery after an accident it was medically urgent to prevent permanent damage. My health insurance company, Anthem Blue Cross, paid the hospital, ICU stay and anesthesiologist without issue. But it has denied the $18,926 surgeon's fee, claiming it lacked authorization from its third-party partner, Carelon. Here's the maddening part: Carelon repeatedly states that no authorization is needed for this emergency procedure."

"Anthem and Carelon refuse to talk directly, leaving me and my surgeon's office stuck in the middle, making over 80 phone calls to try and resolve this issue. Every time we follow Anthem's instructions, it rejects the claim weeks later for a new reason: missing records (they misfiled them), wrong appeal form, or untimely submission even when we acted on its directives. We filed multiple appeals, including one Anthem specifically requested during a three-way call."

"After having emergency surgery, the last thing you should face is a 21-month odyssey through a bureaucratic maze built on contradictory demands and missing paperwork. Anthem's obligation wasn't just to process your claim it was to provide clear, consistent guidance and ensure that its partners, such as Carelon, are aligned on policies for urgent care. Instead, they left you mediating a dispute between their own departments. That's inexcusable."

A patient underwent emergency spinal surgery nearly two years ago to avoid permanent damage. Anthem Blue Cross paid the hospital, ICU stay and anesthesiologist but denied an $18,926 surgeon's fee, saying its partner Carelon had not authorized the procedure. Carelon repeatedly stated that no prior authorization was required for the emergency surgery. Anthem and Carelon declined to coordinate directly, forcing the patient and surgeon's office to make over 80 calls. Anthem repeatedly rejected the claim for shifting reasons, and multiple appeals—including one Anthem requested—were denied. A two-year deadline to resolve claims is imminent, putting the patient at risk of the bill. Under state and federal law, emergency services deemed medically necessary must be covered without prior authorization.

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