bjarvis | Medical, Past & Future

Last April, I had outpatient surgery to repair a torn meniscus in my left knee. Recovery was quick and I've had no problem since.

A few weeks ago, however, I received a letter from United Health about my appeal. Huh? What appeal?

Then last week, I received a letter from United Health turning down my appeal as I had waited past the 180 day term limit. I still have no clue what this is about.

Finally, yesterday, I received a package of correspondence from United Health, a stack of paper an inch thick. Each letter was accompanied by ten pages of statements about how one can obtain services in a variety of languages, how they adhere to HIPPA regulations, etc., but the actual correspondence was revealing.

The 7th page from the bottom of the stack held the secret. Why was there an appeal, for what, and by whom? It was the surgical center where I had my knee surgery. They had billed United Health $9,532, although with a co-pay from me for $364. But United Health had decided the procedures were worth vastly less and were only willing to pay $790.31. Cue the sad trombone, and the appeal.

I could understand their surprise and wanting to appeal the reimbursement from United Health, but it took them nearly a year to decide that, and United is within its rights to reject the appeal because of the 180 day rule. That said, I'm a bit worried about the future.

Will the surgical center simply eat the balance as business transaction gone bad? Yeah, UHG pissed them off, and I could understand if they never wanted to accept UHG patients again. The center really blew it though on the appeal period: missing that deadline was a dumb mistake and they have no one to blame but themselves. But they could also decide that since my insurance provider failed them, they are entitled to extract their extra fees from me as the patient and payer of last resort, even though it has been a year and they've blown their own bookkeeping.

So, I sit and wonder. Will I get a bill for $9k or not? I have no idea.