Pre-approved and paid medical bills later denied by insurance company

Pre-approved and paid medical bills later denied by insurance company (Photo: KUTV)

(KUTV) Years of working in law enforcement and weight lifting have taken a toll Chet Hartley's back.

"I just basically laid in bed for a full year,” he said. “I couldn't even shower."

Hartley's doctor suggested back surgery and Hartley reached out to his health insurance company, Select Health, to make sure that such a procedure would be covered.

"We were approved and had the surgery," he said.

In January, Hartley paid his portion of the bills and so did the insurance company. Shortly after, however, Hartley financially-terrifying news.

"Four months later, I get a letter saying that they did an internal audit and they're not paying for any of it," Hartley said.

Hartley's now on the hook for nearly $100,000.

"Who's got that kind of money? I'm not a millionaire. I'm a retired law enforcement officer,” he said. "If I liquidated everything I had, I wouldn't even come close."

Hartley appealed but was still denied. Wondering how his insurance company can pre-approve and then subsequently deny the procedure, Hartley called Get Gephardt to investigate.

Despite Hartley giving Select Health permission, the insurance company refused to discuss the specifics of his situation.

In a statement, Select Health wrote that, "generally, prior authorizations are approved based on specific benefits, services, devices, and/or procedures."

If the doctor does something different than what was preapproved, “conflict might arise."

Select Health wouldn't say if that's what happened in Hartley's case, nor would they comment on if Hartley's bills would be paid.

A few days later, Hartley says he was contacted by Select Health which informed his that, much to his relief, Select Health would indeed be coving his medical bills.

Select Health says customers who feel as though they have been unjustly denied should go through Select Health's appeals process. Hartley had been through the appeals process, once, and was in the middle of a second appeal when Select Health opted to pay.

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