A family member had a procedure a few years ago. Provider told the patient that they had contacted their insurer and received confirmation it would be covered. Went ahead with the procedure.
Bill arrives and the insurer denies coverage. Provider says "oh well <shrug> you owe us $$$ now".
Since I am the resident argumentative asshole in the family I dig into the situation a bit. After many phone calls I am eventually told that the hospital routinely records all phone calls with insurance companies and furthermore has found the recording where they gave advance guarantee of coverage for the procedure.
At this point I realized we are being shaken down by a corrupt/criminal enterprise. Even with the recorded phone call the insurer refused to pay and so the patient had to pay off the $$$ over many months.
Similar situation with me and a procedure back in 2014. Practice took me on with my pre-ACA insurance. Post-procedure my insurer decided it was a pre-existing condition and didn't cover the procedure. For the practitioner, who went into the deal expecting the reimbursement rate from my insurer, it was a 10X windfall (and he refused to negotiate, citing that he was within his rights to demand the full fee).
Bill arrives and the insurer denies coverage. Provider says "oh well <shrug> you owe us $$$ now".
Since I am the resident argumentative asshole in the family I dig into the situation a bit. After many phone calls I am eventually told that the hospital routinely records all phone calls with insurance companies and furthermore has found the recording where they gave advance guarantee of coverage for the procedure.
At this point I realized we are being shaken down by a corrupt/criminal enterprise. Even with the recorded phone call the insurer refused to pay and so the patient had to pay off the $$$ over many months.