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Insurance company says, 'You're approved,' then refuses to cover the bill

Insurance company says, 'You're approved,' then refuses to cover the bill (Photo: KUTV)

(KUTV) Adam Brinley's knee hurt. His doctor suggested he get an MRI.

Brinley knows better than to go get something like that without first clearing it with insurance, so he called and was told “it’s approved.” In fact, a recording of that call shows his insurance company’s representative told him it wouldn’t cost him anything.

“You know you've met your out of pocket, so anything you want to get done, get done because we'll pay for it all," his insurance company told him by phone.

But months later Brinley got a bill. He appealed, reminding the insurance company they’d told him the procedure was covered but his appeals were denied.

Brinley said he feels deceived.

"I feel like at some point I should be able to reasonably rely on my insurance company and their representations on how much my healthcare is going to cost," he said. "I did everything that I feel like I could have done to make sure that I did this properly."

A spokesperson from Brinley’s insurance company, Bridgespan Heath, told Get Gephardt that the imagine center where Brinley had the procedure done was actually not in-network with the insurance company.

Not pointing that out to Brinley was apparently an oversight. Bridgespan said their customer service professionals usually advise if an office "is in or out of network" but it "did not happen in this instance," Bridgespan wrote.

And, recognizing the oversight, Brinley received long-awaited good news: Bridgespan will be covering the MRI after all.

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