The procedure was approved by the same insurance company for another lady under the same plan and the same doctor. The normal steps were taken. A doctor's visit to diagnose, the request for approval was sent to the insurance company, and it was approved. It was at least several months before the procedure actually took place. Then here recently (4 months after the procedure) we get a bill from the doctors office saying we owed 5000 for this procedure that had been authorized already by the insurance company.... Even though the procedure was needed for my wife's health we would not have not gone through with it because we did not have an 5000 in the bank. During a checkup visit yesterday the doctors office explained that the insurance company had requested that the money for the procedure be returned within 10 days!?!? so they returned it. Now we are suppose to pay the 5000!?!? Shouldn't the Doctor or insurance company be at fault? What can we do? What is be the best course of action?
Additional Details
It turns out that *Jane* from the doctor's office called the insurance company asking for Preauth, the insurance company replied that it was not needed for that procedure. The insurance company has now said the procedure lacked medical necessity to be covered. The doctors office gave us what looked to be a summary of what happened from their stand point but I do not see a unique identifier like a name of call number etc that could be tracked back to the person that answered a preauth was not required. Surely there should be some type of traceable call number, request number or something that can be used to track it back to the insurance rep? If that is the case we will be liable if the insurance company replied that the pre auth was not required? Should the doctor's office doubled check? I mean we are paying over 500 in premiums a month, we are doing what we are suppose to do by going in network, are we suppose to double check everything the doctors office and insurance company does?!