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

"I desperately need your help with Anthem Blue Cross. 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."

"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. They denied it anyway. The cruelest twist? Anthem imposes a strict two-year deadline to resolve claims. Our window slams shut in a few weeks. I'm exhausted and terrified of being stuck with this bill. What can I do when the insurer and its own partner can't agree on their rules?"

A patient underwent emergency spinal surgery that was medically urgent to prevent permanent damage. The insurer paid hospital, ICU, and anesthesiologist charges but denied the $18,926 surgeon's fee, citing lack of authorization from its third-party partner. The partner repeatedly stated that no authorization was needed for the emergency procedure. The insurer and the partner refused to communicate directly, leaving the patient and the surgeon's office to make more than 80 calls. The insurer repeatedly rejected claims for changing reasons, and multiple appeals were denied, while a strict two-year deadline to resolve claims nears.

Read at The Mercury News