Insurance co. won't pay woman's surgery billPosted: Updated:
PHOENIX -- A West Valley woman says she is stuck with a $27,000 surgery bill all because her insurance carrier doesn't want to pay.
I am getting more and more complaints about insurance companies and the complaints all have to do with the same thing. People say they pay their premiums, but when it comes time for the insurance company to pay for something, well, consumers claim there's always a glitch.
Emptying the dishwasher seems like a simple task, but for years Ana Escobar avoided it because just putting dishes away was too painful.
"It was miserable," she said. "I couldn't do anything. I was in tears a lot because of the pain."
Finally, Escobar saw a physician who recommended that in order to get rid of years of constant pain, she had to have surgery.
"I needed surgery, they said, because my disk was bulging and they needed to take it out," Escobar explained.
Good thing Escobar was insured with UnitedHealthcare. She and her physician asked the insurance carrier for authorization for surgery.
In response, UnitedHealthcare sent Escobar a letter saying, "We are pleased to inform you that coverage is available."
So, Escobar had that $27,000 surgery and, as a result, she is pain free.
"I feel great," she said. "I mean I can go dancing because that's what I love to do. I'm just so happy."
But Escobar's backache turned into a headache when a year after that successful surgery, UnitedHealthcare denied payment and decided it wouldn't pay for that $27,000 surgery after all and that she would have to pay.
"Well, I went into a panic, you know," Escobar said. "It's $30,000 and I thought, 'Oh no, what do I do now?"
3 On Your Side reviewed that original UnitedHealthcare letter to Escobar indicating coverage was available, but we also noticed it said something else, "Please note this letter does not guarantee payment."
Escobar says that's not very comforting.
"They're saying they are not going to pay -- $30,000 -- what am I supposed to do?" Escobar said.
UnitedHealthcare has finished its investigation and guess what? They are sticking Escobar with the entire $27,000 bill, saying her surgery was considered "experimental and investigational" and experimental surgeries are not covered under her plan.
They claim the original approval was for a particular procedure, but that the doctor performed another procedure that was not approved.