This will require some phone calls, and it might not be settled quickly.
A little backstory. Kid #2 born with a (non life-threatening) birth defect that needed to be fixed somewhere around the 9 month to 18 month mark.
As we approached that time, pediatrician referred us to in-network specialist.
In network specialist does not do the surgery anymore, referred us to university hospital.
As part of this process, we got a pre-authorization code for the surgery from my insurance.
Have the surgery.
Get the EOB from my insurance. "We are covering $0 because this was not an emergency surgery." Well, no shit. That's why the pre-auth.
So, we had many phone calls to make to insurance, our home doctor group, and the university hospital. Some issues:
1. The pre-auth number had expired, so they had to issue us a new one.
2. One reason for the pre-auth and the referral is that my insurance company will only pay a bill to the home group. So...the bill *should* have been sent to the home group to forward to insurance. Instead it went right from university hospital to insurance.
3. Still, with phone calls and such, very little got paid. You see, my child had double coverage from his two parents, but mine was the primary. So, a small bit was covered by the secondary.
4. In the midst of all this, we had open enrollment at work, and lo and behold, I see the "outpatient responsibility" of $125. We call up the university hospital, and they say "why, you are right! Let's see what we can do!" And eventually, they accepted our $125 payment, the paperwork got worked out between the insurance company and our doctor's group.
5. Lather, rinse, repeat for the surgeon. I kid you not. Separate billing.
In the end, the bill was fully paid a full 18 MONTHS after the surgery. 18 months. Surgery was something like $20,000-25,000.
This was not my first experience with things getting lost "in the middle". In this case, the doctor home group was the middle man between hospital and insurance. In a prior instance, there was a "repricing" company that simply LOST my husband's annual physical info for 2 years. He had to get the actual fax # of the individual at the repricing middleman, and make sure that he got the bill from the doctor. Then he had to make sure the insurance company got the bill. By the time it got paid, we weren't even on that insurance anymore.
And then there was my first childbirth...ahhhhh.
I'm very sorry. Get a notebook. Write it all down with names and dates. Try and be patient.