Customer Told Insurance Would Not Cover His Surgery, Despite Pre-Approval And Payment

By Consumers for Quality Care, on August 7, 2017

Chet Hartley, a retired law enforcement officer, was in for a shock when he received a letter from his insurer saying they would not cover his surgery, months after it had taken place.  KUTV explains, the letter said the surgery would not be covered, despite the fact that Hartley received pre-approval and had already paid his portion of the bill.

Hartley’s surgery came after a year of being bed-ridden from back pain.  When his doctor suggested back surgery, Harltey reached out to his insurer, Select Health, for preapproval.

“We were approved and had the surgery,” he said.

After the surgery, Hartley paid his portion of the of the bills, as did Select Health.

“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. 

The amount his insurer said he now owed was close to $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 the bill to his insurer, questioning how the insurance company could pre-approve and then retroactively deny him coverage.

His first appeal was denied by Select Health.

After reaching out to KUTV and submitting a second appeal, Hartley was notified that the insurer would cover the surgery.