'Denied. Denied. Denied': This Florida woman’s insurer didn’t pay a $150K bill for ‘medically necessary’ surgery — after telling her they would. Here's how the provider's story changed

Insurance company denies patient’s claim

The day before heading into surgery, the hospital called to cancel because they hadn’t received the approval from the insurance company. Rogers called the insurance company for more information about the late approval.

She said, “I had spoken to the insurance company about the approval, and I was told on a recorded line, do not worry if you don't have the authorization ahead of time. As long as the doctor deems it medically necessary, you won't have any problems.”

Since her condition was life-threatening, Rogers decided to move forward with the surgery anyway. She paid $26,000 upfront to receive the care.

After the surgery, Rogers received a bill from the insurer indicating that they had denied the claim, and she owed $150,000 for her care. Immediately, Rogers started the appeals process. She went through two rounds of appeals and a peer-to-peer review by medical professionals without getting anywhere.

Finally, she reached out to the I-Team at ABC Action News to share her story. The I-Team reached out to the insurance company, Oscar, about the issue.

The next day, Rogers received news that her claim was approved.

“I was floored to hear from them so quickly," Rogers told the I-Team.

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What to do if an insurance company denies your claim

People in the U.S. owe a total of at least $220 billion in medical debt. Most of that burden is on individuals who owe more than $10,000 in medical debt.

If you find yourself facing a mountain of medical debt after a denied claim, start by appealing your insurance company’s decision. Patients with denied claims have the right to appeal the decision both internally and externally.

Generally, you’ll start with an internal appeal, which involves your insurance company conducting a full review of the situation. Without a resolution, you can move to an external appeal, which involves an independent third party reviewing the situation.

Another option is to negotiate the medical debt with the provider. In some cases, they might allow you to pay a lower amount to clear the debt. Many hospitals offer some level of financial aid. If you qualify for financial aid, this could relieve your medical debt burden.

When possible, start with the hospital’s billing department for guidance on your options. But if you need additional help, consider working with a medical bill advocate. Medical bill advocates can help you navigate the billing system.

In the best-case scenario, the insurer will cover the claim. But even if your insurer foots most of the bill, you’ll likely face some out-of-pocket costs surrounding a major medical event. With that, it’s helpful to build up savings in a Health Savings Account or a Flexible Spending Account to cover medical costs.

Finally, building a solid emergency fund to lean on during unexpected medical events can take some of your financial stress out of the equation.