The insurance company agreed to cover the surgery. Paying a politician paid paid bills.

Kara Anthony

For the largest part, Keyanna Jones and her husband believed that they knew what could be expected when their daughter Chloe underwent eye surgery last fall.

Even Chloe, who was in kindergarten, had a good understanding of how things were going on that day. Before the operation, a hospital worker gave her a clearer coloring book – a procedure to correct a condition that could eventually overlap with her vision.

“Chloe is very smart,” Jones said. “She reads approximately the third grade level, and it is only 6.”

Jones also made her duty. With the lack of ophthalmologists in children near their home in Winzville, Missouri, who will take their insurance, I asked the insurance company to cover kidney care outside the network as if it were in the network. The insurance company agreed to allow it to see a specialist outside the network.

Chloe performed through surgery without an obstacle. Jones said her daughter enjoyed some of the hails in the hospital before going home.

She said: “She slept with her every night because she was very concerned that she would wake up and will not be able to see her.” “But she was beautifully healing, and she was completely ready to return to school.”

Then the bill came.

Medical procedure

Chloe was born with a fluter eyelid, a condition known as the installation. To correct the problem, an eye specialist raises the surgeon of the eyelid, and prevents it from disrupting the patient’s sight.

Ophthalmologists, unlike optical specialists and optical specialists, hold medical degrees and can provide advanced eye care, including surgery.

The final bill

$ 15,188, including $ 10,382 for procedure and $ 2,730 for anesthesia. Initially, the insurance paid only $ 1,775.79, leaving the Jones family for $ 13,412.21 – until Klawi’s uncle, who recently ended his term from his colleague from his colleague in searching for him.

The problem: the approval of fake insurance?

Months of Chloe anesthesia, inhaled by Popljoom at the Cardinal Glenon for Children in Saint -Lewis, Jones discovered that it may be difficult to find a pediatric ophthalmologist. The physician who recommended a pediatrician in Chloe with their insurance company, UNITEDHEALTHCARE, was not contracted, and was the closest specialist in the network in Wisconsin, hundreds of miles away.

Therefore, Jones requested what is called an exclusion of the gap in the network, according to which the insurance company will cover the recommended doctor’s services as the network.

Before determining the date of the surgery, she received a letter saying that Unitedhealthcare has agreed to her request, “Because there is no doctor, health care specialist or facility in your area to provide these services.” The message included many symbols of eye services for eye services and said it would cover “network level”.

About a week later, the insurance company sent a pre -authorized letter dies from kidney surgery.

But UNITEDHEALTHCARE refused to pay most of the surgery bill, which it covers as outside the network. Jones said she was with approval messages on hand, she did not understand why the insurance company seemed to have not incurred her approval to cover her daughter’s treatment.

In fact, similar messages gave the appearance different types of approval.

UNITEDHEALTHARE’s GAP Exception agreed to Chloë before surgery as a network. But in the letter of the previous statement of the surgery with the same doctor, the insurance company only said it would cover it – without providing discounts on the network.

After receiving the bill, Jones contacted the online insurance company, but she told an actor who told her that there is no record of agreeing to cover the surgery as a network.

“At that point, I didn’t even know what to do,” she said. “I like,” this is crazy. “

She said that she sent a copy of one of the approval messages, which was at the head of the company, but an actor told her that the message did not come from UNITEDHELTHARE.

Jones said, “They said:” I have seen this wound, and they were not covered and did not have permission, so, no, we will not pay. “

Insurance representative Jones said she owed more than 13,000 dollars because of the “balance of bills”. This means that the Jones family will have to pay the balance of more than $ 13,000.

UNITEDHEALTHCARE spokesman confirmed that the company provided an exception to the gap and the prior licensing of Chloe’s care. “We are sympathetic to anyone who finds themselves in the unfortunate situation of its balance by an provider outside the network with a much higher amount of market prices, and without any prior knowledge,” Eric Hausman, a spokesman for the United Holth Group, said in a statement to the news of KFF Health News.

Marian Wallace, a SSM Health spokeswoman, presented the health system that includes the Cardinal Glenon Children’s Hospital, a statement said that SSM followed “standard bills procedures”.

“Sometimes, the insurance company may treat a claim as a service outside the network, which can lead to a balance of the patient,” the statement said.

decision

Jones said it was fatal from the big bill. She said she tried to fix the problem alone, and follow every interaction with the insurance company and the hospital. I made calls with unitedhealthcare.

Nothing helped – until she contacted her brother Kalb Rodin, who was Senator Missouri for eight years after she spent four years in the House of Representatives.

She said, “I have never used my brother’s political influence for anything.” “I actually hate politics.”

Rhodin Kff Health News has told Travis Fitzotter, a member of the Senate of his niece’s daughter. Jones called Fitzotter, and also sent a complaint to the Prosecutor of Missouri Andrew Billy.

Fitzotter said that his office no longer had more than it was for any component.

He said in an interview: “We will not take much credit for that, because we did not ask anything other than the decision, so that everyone can be in peace and continue in their lives.” “We did what we do every day.”

After calling the hospital Fitzottot staff and the insurance company, both Jones representatives were separately and informed it that UNITEDHEALTHCARE paid the bill completely.

In the end, the Chloe family did not pay anything for her – not even Copy.

Ready -made meals

When it comes to insurance approvals, read carefully print; The “covered” does not mean that the insurance company will pay, not to mention the network prices.

Rodin and Vittoter said that communicating with your representative’s office could help. The voter call is part of their job.

“They usually have an open communication line with these insurance companies and hospitals,” Rodin wrote in an email. “They may not always be able to reach a positive result because each situation is slightly different, but they can usually reach a next step.”

Jones is grateful that her brother was able to help, although she admitted that she might have not contacted him without paying their mother. She said, “I think I am still fighting.”

The bill of law is a collective investigation before KFF Health News and Washington Post+ An dissection and explanation of medical bills. Since 2018, this series has helped many patients and readers reduce their medical bills, and it has been martyred in the states of the state, in the American Capitol, and in the White House. Do you have a confusing or interesting medical bill you want to share? Tell us about that!

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