<p>Binx, this will be resolved, in your favor. It’s just a pain until it is. Relax. The hospital is on your side.</p>
<p>BTW: I do thing getting the benefits person at your (or DH’s??) company involved is a good idea. The insurance company has an interest in keeping them happy.</p>
<p>^^^^ VeryHappy-
THe voice of reason! You are correct on all fronts!</p>
<p>Thank you, thank you!</p>
<p>(Didn’t I tell you at lunch the other day that The Story of My Life is to say wonderful things, have people totally ignore them, and then have someone else say the same thing 15 minutes later to brilliant applause and praise??)</p>
<p>^^^ Yup, you did, and this time you are repeating what I said several posts ago (posts #12 and 32), so of COURSE I think it is brilliant :D</p>
<p>Great minds think alike. :)</p>
<p>Yup-- now all we have to do is help binx get ther insu snafoo resolved. As you (and I) said-- it will-- it’s just a hassle. There is a difference between people who sell shoes and people who wear them, if ya know what I mean…</p>
<p>(edit-- and those who might consider making a snarky comment about how we can’t or won’t be able to help Binx-- don’t go there…)</p>
<p>binx</p>
<p>Glad today was better. I wish you could join me in my hot tub under the stars. Though right now it’s also in the sleet–we’ve learned to adjust.</p>
<p>Ah! Sorry Binx. These are the experiences Jules Fieffer used to call “life’s little murders.”</p>
<p>I also think it absurd to expect a young person to pre-diagnose herself before going to an emergency room. Sheesh. That’s what it’s for!</p>
<p>Hot tub sounds great! </p>
<p>Mythmom - remember my D’s first words to you? - That she assumed you knew all about her passing out, since I post “everything” on CC, and how suprised she was to learn I hadn’t posted it? Now I wish I had - I’d have a process recording of the whole awful day, from the 7 a.m. phone call from the roomie, to the updates from the hospital “They don’t know what’s wrong…They don’t think it’s flu, but they’re testing… It IS flu!”… It had just happened the previous week, when you met her.</p>
<p>But at least I’ve NOW posted everything. :)</p>
<p>I like that - life’s little murders.</p>
<p>Yes, I do remember.</p>
<p>It’s a d<strong><em>ed if you do, d</em></strong>ed if don’t situation that the insurance industry puts us in. Because if she hadn’t gone to the emergency room and something serious had happened, that would be her fault too! in their eyes.</p>
<p>She’s such a lovely girl. Thank goodness money is the sticking point here and she’s okay. Doesn’t make it less frustrating though, I know.</p>
<p>I’m having a crummy day today. I have to fire someone and I don’t want to do it. I’m much too empathetic and non-confrontational to do this properly. Wish me luck and the right words.</p>
<p>Sorry to hear that, Karen. That is no fun. You can see if some of the other posters might do it for you-- those that are more comfortable with (perhaps even enjoy) confrontation. That wouldnt be me. Good luck with a no-fun task.</p>
<p>When my son was in second grade I had to take him to the emergency room associated with our insurance for an asthma attack that I could not resolve with our home nebulizer. We were not allowed to go to our Children’s Hospital.
At the first hospital, they started an IV, gave him steroids, another nebulizer treatment, IV antibiotics. He was on an EKG and pulse oximeter with VERY low oxygen levels. They were afraid they would have to put him on a vent and he was finally transferred to Children’s. He of course went by ambulance with an RN attending him.
THE BILL FOR THE AMBULANCE WAS DENIED!!!
I logged the hours I spent on the phone with the insurance company stopping finally at 13 real time hours. The reason went from ambulance wasn’t needed, to ambulance cost was above normal and usual charge to the ambulance provider was not on our policy. ALL of the above reasons had no basis after I researched them all.<br>
I went online to the state commisioner of health insurance. There was a form to file on-line that detailed your grievance. Within 48 hours of the insurance company being contacted by the state, the bill was paid in full.
If your state has something like this, I would strongly suggest looking into it right away. I could have saved a day of my life dealing with this ludicrous situation.</p>
<p>keymom-
Congrats on getting your denied ambulance claim paid! You did the right thing-- you did your research! That’s how you get this stuff resolved successfully. One time it took me 10 months to get something resolved. Fortunately I had every name of every person I spoke with, the date, time, gist of each conversation, documentation that I did what I was told to do by each claims rep and supervisor, copies of my written correspondence and records I’d sent (at their request), documentation of what was a covered benefit under the plan, etc. Finally got about $2500 worth of services covered that had initially been denied. I’ve learned, from that experience, to do things a little differently so it doesnt take 10 mos of time, energy, calls, letters, appeals, etc to get it fixed. </p>
<p>Since then I’ve gotten some big bills reprocessed and covered, including a situation where the insu. carrier tried to deny a second ambulance trip that occurred on the same day (when my s had to be transferred from one facility to another) as a duplicate claim. In the first case I described above, I was reimbursed about $2500. I got about $1000 worth of ambulance bills (45 mile drive around a mountain!) covered in the second situation, and in a third situation, when my s had to be transferred to the hospital that was equipped to handle his shattered femur and perform the surgery, the insurance finally covered that second facility as “in network” when it was out of network, because the first (in network) hospital he was taken to wasn’t equipped to handle the necessary surgery. That saved me about $2600. So in these 3 situations alone, the insurance carriers, two different carriers, but both big name, well respected carriers (my H worked for a Fortune 100 company and they had great benefits… supposedly) finally, appropriately covered over $6000 of initially denied claims. Imagine all the people who don’t know how to navigate this system and would not have appealed the denied claims that really should have been paid by these good, well known and well respected insurance carriers? The insurance companies are making millions in unnecesarily delayed or denied claims.</p>
<p>Yes, education is the way to go. And when necessary, contacting the insurance commissioner and even the media is the way to go too. My professional organization is in the middle of one of these issues right now with another big name insurance company that has tried to pull stuff that is against the providers’ contracts. (That is a long story for another time). Doesn’t it feel like the insurance companies are happy to take our premium payments, but dont want to pay claims?? No wonder these insurance companies have had increasingly high, record profits.</p>
<p>How true about inappropriately denied claims being paid by unsuspecting people who just “trust” the insurance company or get fed up with the time it takes. The other thing that happens is that the unpaid bill to the provider goes to collection and then people panic and pay the bill.
The company I dealt with is one of the big “highly respected” companies. I firmly believe that claims are sometimes just denied at random. There was no logic in anything I heard from this company. The lies about not in our policy were easily disproved!
The state also responded to me that when people go to them for help they can see a pattern by insurance companies and they can actually be fined if there are many problems.</p>
<p>I agree with you keymom. Also, when you have a family member, or you are ill, this is when you have the least amount of energy to go through the red tape, or spend time on hold. We needed to fight with our insurance company years ago for some ongoing care that they denied. It is only because my H is an attorney that we could go through fighting their decision. We were able to get the insurance company to pay. Your average person could not have gone through all of that.</p>
<p>I ws worried that In Binx’s D’s case, the FAINTING was not well documented in her record. If BinxD is alert and talking at time of presentation, then the fainting spell would need to be front and center of her chief complaint - 18 year old female with 3 day history of flu symptoms or N&V, etc.</p>
<p>My experience may not be relevant, but my D went to the ER OOS in high school once on a church trip. It was her first time skiing and she fell several times - imagine that. One of the boys on the trip fell, and bit through his tongue, so he had an obvious emergency. By the time he fell, she had stopped skiing because of pain in her knee, and was limping a bit. So the boy’s mom, who was one of the chaperones, took them both to the ER. The entire bill was denied originally by my insurance company, almost as a matter of course with an OOS charge, but after a couple of phone calls, all appropriate charges were paid. This was about 5-6 years ago now, things get worse each year.</p>
<p>jym, thanks for the encouragement. While the stomach was churning, I was able to be calm and coherent. Tomorrow, I have to start interviewing replacements. Not fun, either.</p>
<p>Hi cangel,
Your experience with your D. is very relevant. Amazing how many initial claim denials occur that should and do ultimately get paid, and what it takes to get it resolved appropriately. I do think you are right - that probably since binx’s dau was awake and alert by the time she got to the ER, that perhaps someone didn’t document the initial loss of consciousness, or perhaps didn’t list it on the charge ticket. Oftentimes different people handle different aspects of the chart, especially in an ER, and if whoever did the billing coding saw the final diagnosis of “flu”, thats probably what they put on the bill, without adding the initial presenting symptom. In all likelihood, if the hospital wants to get paid, they’ll work with her to get the additional clinical information to resubmit the bill with the additional dx (its just a good idea to, if possible, find out if it is a covered code for and ER visit). As long as binx is working with her insurance co to get a claim reconsidered, she doesnt have to pay the outstanding bill. She’ll probably get monthy bills from the hospital, but as long as she stays in communication with them (assuming the hospital will talk to her about her adult dau’s claim) she should be able to stave off nasty dunning letters from the billing dept. FYI, binx, do get your dau (since she is over 18) to give permission for you to be able to talk to the hospital and the insu company.</p>
<p>Karencolleges-</p>
<p>Hang in there. Management responsibilities have their good and bad sides. I am sure you’ll find a great replacement.</p>