My father had passed away back in Nov 2025 and was in the hospital. The hospital was Medicare eligible as were the doctors. However, my mom received a denial of coverage for a particular doctor that did a CT scan. My dad had several CT scans performed by various doctors, which all were billed by the same radiology company and were covered by Medicare. Medicare is supposed have policies in place that prevent surprise billing like this. Technically, Medicare isn’t covered by the Surprise Billing Act because they have their own procedures. Does my father’s situation merit a successful appeal? Is there specific language or cites that can be used to support an appeal for denial of this particular doctor’s CT Scan when the other doctors CT Scans were covered?
Having delt with my mother in a similar situation, I’d make sure that a) the CT scan was done and b) the practice submitted it correctly. I doubt this is a surprise bill. It smells like a clerical error.
Did your dad have a medicare.gov account? You could look up everything that was billed and Medicare’s response.