I broke my right elbow 5 days ago and am in agony pain killers are not even helping. I am scheduled to get surgery today.
When I chose this insurance policy, a key deciding factor was the clear reassurance that in-network hospitalization would be covered at 100% (subject to the stated co-pay and annual limits up to 60k). This promise gave me confidence that, in the event of a serious medical need, I would be protected from unexpected and overwhelming financial burden.
I carefully followed all required procedures and selected an in-network provider for my treatment. Despite this, I was shocked to receive an authorization approving only €4,195.63, while the hospital’s estimate is more than double that amount. This discrepancy is extremely difficult to understand in light of the coverage I was led to expect.
The surgery involves an olecranon resection and an arthrotomy/arthroscopy to treat a significant joint injury. These are not separate or optional interventions, but parts of one medically necessary operation, confirmed by my treating physician. Without this procedure, I risk long-term loss of function in my right arm, with serious consequences for my daily life. These are deemed medically necessary by my doctor.
What makes this situation especially distressing is the timing. I am writing this just hours before surgery. I am being confronted with the possibility of an unexpected and substantial payment at the hospital that I was not informed of and cannot realistically absorb at such short notice. This has placed me under extreme emotional stress at a moment when my full focus should be on preparing for a necessary medical procedure.
I am experiencing significant anxiety and uncertainty due to conflicting information regarding what is covered and what is not. This lack of clarity, at such a critical time, is deeply distressing and unacceptable.
I am therefore requesting an immediate and definitive review of this authorization, with urgent reassessment of the approved amount to ensure it accurately reflects the medical necessity of the procedure and the coverage terms I was promised when taking out this policy.
At this stage, I need a clear, consistent, and urgent resolution without further delay. I trusted MGEN to provide reliable protection in situations like this, and I sincerely hope this matter will be treated with the seriousness, care, and urgency it requires.
