hospital didn't get pre-cert for chemo?

hyphencollins

I got a bill from my hospital for $3500. When I called Cigna they said the chemo wasn't precertified. Apparently other treatments weren't as well and weren't paid (but I haven't received any bills yet and some were the month before the one I was billed for). Cigna said they had no authorizations on record. Cigna also said the provider has to eat the cost if they dont precert. I'm calling the hospital tomorrow, but am pretty stressed. Any tips?

Beatmon

I believe that to be true...hospital is due the bill. I had a emergent cat on admit that wasn't covered same reason...insurance refused....it was a 4 pm admit. They are resubmitting but not billing me. Good luck.

vlnrph

Cigna is a big company. How large is your hospital? Perhaps someone "lost" your approval or put it in the system incorrectly. Hopefully it's all worked out by the time you read this.

However. sometimes I think insurance will refuse to cover things and figures either you will pay or the provider will write it off: that's the way they make a profit! In my case, I did have prior authorization for two separate issues yet could not get reimbursement until I complained to our state government. Checks were released within weeks (after months of unproductive communication and attempts at clarification) with interest added due to their delay...

All that to say, if you have a contracted benefit denied, don't give up. Find out the terms/requirements of your policy - they are often available on line, although not easy to decipher. There are appeal processes & you can win. I will bump the thread I started in 2013 when my problems began.