<p>And you know what? You may have access as a student to free legal aid at your school. They might be able to help you, too. Insurance companies are fraudulent, IMHO, if they take your money but refuse to pay for medical care when your doc/nurse sends you for that care.</p>
<p>I’m going to guess that this claim ends up being paid once the insurance company receives more information from you. It makes sense that they have procedures in place to discourage their subscribers from using expensive ER facilities unnecessarily. Like others above, I have had claims initially rejected that were always paid once I provided more information.</p>
<p>As eastcoast pointed out, it is important that you read the terms of your coverage; all companies I have used have required that they be notified by phone within a specified time period (24 or 48 hours) when out of service providers are used, and often require pre-certification. These are terms you agreed to when you contracted for coverage. If you carry your insurance card (with telephone numbers) in your wallet at all times, it should not be difficult to comply.</p>
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<p>True. I have friends who have worked for insurance companies. They are told to reject pretty much all claims in the hope that people will just slink away and pay them themselves. Appeal! Fight if you must. That’s the fun system we live with.</p>
<p>Batllo gave great advice.</p>
<p>I’ve lost track of the number of appeals I’ve filed over the past 20 years. All of them got paid eventually. I truly believe that some insurance companies just say “no” first, hoping that the client will not appeal. </p>
<p>Good luck!</p>
<p>I’ve done an appeal before (wrote a letter explaining the cercumstances) and it was sucessful. Just remember to be professonal about it.</p>
<p>Hospitals tend to get more money from insurance companies than Self Pays, so they usually have an incentive to get the claim covered. In addition to what’s been suggested, sit with the hospital billing department and see if they can find documentation that will let them put in diagnoses codes that they may missed the first time around.</p>
<p>In my experience with insurance…they try to wear you down. I think they try every obstacle imaginable and some that are unimaginable to prevent paying a dime. Appeal, call and don’t give up. They will eventually pay I would bet, but they will make you work for it. I think that they believe some will think it is not worth their time and energy and just pay it, letting the insur co off the hook…don’t do it, you have the insurance, make sure they keep up their end of the bargin. So sorry your in this situation.</p>
<p>Remember that insurance companies make money by delaying payment as well as by denying payment. Every day they hold money in their accounts is more money in their bottom line.</p>
<p>If you look at what has happened in the health insurance industry in the past 20 years you find something interesting. The increased costs reflect lack of investment income to a greater extent than they do new technology, legal liability, new drugs, etc. When the balloon gets squished down at one point, it has to balloon out at another.</p>
<p>You had worrisome symptoms. You called the advice nurse and described the symptoms. The nurse advised you to go to the ER. Seems like you followed appropriate protocol.</p>
<p>Go gettem!</p>
<p>Let us know how your appeal turns out. You will prevail. Ins co counts on some people not knowing or bothering to appeal.</p>
<p>Reviving an old thread. I just wanted to let you guys know that my appeal went through and my ER visit was covered in full. Thank you so much for all your support! Your reassurance and advice made my life a lot easier!</p>
<p>Thanks for the update and glad it all worked out!</p>
<p>That’s great. Thanks for the update.</p>
<p>Remember in the future, document, document, document so that if your insurer denies, you will have your paperwork in order to submit. Glad it worked out & that you’re fine & it was paid as it SHOULD HAVE BEEN ORIGINALLY!</p>
<p>Appeals often work because insurers have every incentive to get it wrong and leave appealing to you. One of my kids had a procedure done by her primary care office at a surgical center and it was rejected because there was no referral. There wasn’t a referral because it was the primary care doctor and the office had filed the required paper. Took the office redoing the paperwork - imagine that cost - to get them to process this properly.</p>
<p>Appeals are just more work for everyone & insurers bet that many patients will just not bother & pay it. They are more careful about denying appeals because it could start them toward being found guilty of bad faith if the appeal was timely, provided the documentation & they still refused to pay. Bad faith can be VERY costly for insurers.</p>
<p>Today, we received a letter from a collection agency in Minnesota from a doc based in Virginia who treated my d. at an emergency room in DC about nine months ago. Only thing is, we had never even once received a bill from the doc. We are now wondering whether he billed the insurance company, too (part of the “bill everything that moves” routine.)</p>
<p>Did your D receive a bill & perhaps not forward it to you? It’s odd for you to get a letter from collection if NO ONE got a bill for her services form the doc. I’m sure you’ll resolve it, but irritating!</p>
<p>So glad to hear that it was finally paid! </p>
<p>Mini, I have heard similar stories from others. It’s almost as if you were somehow expected to have known that you owed money and followed through on your own. I know I don’t pay anyone without a proper invoice … if it’s not received, it’s not paid.</p>
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<p>If you receive an Explanation of Benefits from your insurance company after they pay their portion of the claim, you will be on notice that you owe money (or not).</p>