Family claims Atrium Health didn’t obtain pre-authorization prior to hospitalization

Updated: Jul. 17, 2020 at 7:19 PM EDT
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CHARLOTTE, N.C. (WBTV) - A Concord couple is facing a $27,000 hospital bill for treatment they thought was covered by insurance. After fighting with the hospital for 9 months, they turned to WBTV.

“It’s a headache, pretty much,” said Desree Moner.

In October 2018, Moner’s son Elijah, then 17, was admitted to Atrium Health Cabarrus. Moner’s wife says she presented the required insurance during admissions, and since no one at Atrium indicated there was a problem, she went ahead with her son’s treatment. Everything appeared to be fine until a bill arrived 1 year later.

“We never saw a bill until, like I said, December of 2019.”

It turns out that under Moner’s insurance with Anthem BlueCross BlueShield, the hospital treatment needed “pre-authorization” prior to Elijah’s admission.

“Prior to admitting him into the hospital they never got the pre-authorization and those things are put in place so you don’t end up with a bill.”

The Moner’s claim Atrium Health did not obtain pre-authorization until after his admission into the hospital and because of that, the pre-authorization and coverage was denied.

“If insurance was not going to cover it or they didn’t feel it was necessary or whatever the case may be, then the hospital could have told us before he was even admitted to the hospital.”

Moner says if he had known there was no insurance coverage before treatment, they never would have moved forward and would have explored other options. Now, Atrium has turned Moner over to a collection agency demanding $27,000.00.

”Discouraging and stressful. That’s basically the whole ordeal.”

WBTV Investigates on Wednesday contacted Atrium Health and outlined this case. We asked Atrium Health to look into the case and to give us their side of the story. We were told, “billing matters are typically complicated and take some time to research. We are looking into this matter and will respond when we have something to share.”

So far, we have received nothing. In the meantime, this family is dealing with uncertainty and a massive bill looming over their heads.

“I feel that someone dropped the ball and didn’t do their job and they’re trying to either cover it up or they’re trying to gloss over it.”

We contacted Anthem BlueCross BlueShield and they provided this statement:

“Anthem is dedicated to delivering access to quality care to our members, providing greater value to our customers and helping improve the health of our communities.

Per Mr. Moner’s benefits, the provider is responsible for securing any necessary preauthorization for hospitalizations. However, the provider submitted the preauthorization after the hospitalization and upon review, the hospitalization was deemed medically unnecessary and the claim was denied. It’s unfortunate the member received a bill a year after service.

We sympathize with Mr. Moner and are working to help resolve this situation.”

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