<p>We had this happen a couple of years ago when we were out of town and had to take our son to the ER. The hospital was covered but we got a bill from the doctor.</p>
<p>I called the insurance company to ask about it, and they told me to just fax the bill in along with a request for payment. They paid it with no problems (I was surprised).</p>
<p>I’d say it can’t hurt to give the ins. company a call, if you haven’t already.</p>
<p>So if I go to the ER I must ask everyone individually, doctor, nurse, physician’s assistant, anesthesiologist, (written question on clipboard after I get knocked out), if they accept my insurance?</p>
<p>Do not pay until you are sure you have the right answer, because getting a refund won’t happen. I would make phone calls and follow up in writing. I was billed over and over for a dr visit my son had while at school. I knew i had a referral (hmo) but the insurance kept rejecting it. Finally I got someone at BlueCross to tell me the Dr office had been billing some other branch of BlueCross and that was why it kept coming up as no referral.</p>
<p>It is probably just a coding or billing issue. The Dr office may not have submitted it as Emergency care which might make a difference in whether they are considered in network. They might be submitting it to the wrong insurance office. I think I might have had this problem when hubby went to hospital while we were in Kentucky. I think I sent copies of the Emergency Room bill (highlighting emergency) and maybe an ER report along with the unpaid bill to the insurance company with a letter explaining.</p>
<p>I cannot believe the doctors in the ER would not be paid. If you were admitted it might get trickier…imo.</p>
<p>No, NJRes, what we all should do is read our policies. Understand what they cover and how. Emergency visits usually fall into their own categories, since you don’t have advance time to get approvals from the ins co. I took a quick look at a PPO handbook for Cigna last night and they do pay out-of-nwk docs for this- according to that info (I can’t know if it matches exactly the policy OP has, what her copays would be or if she would even have copays for those docs.)</p>
<p>OP, please keep us posted, so we learn.</p>
<p>I was under the impression that ER visits at an in-network provider were covered with a $175 copay-- all my copays are listed on my card and that’s what it says in my paperwork. Interestingly, I haven’t seen a charge for that anywhere. It said copays were due at the time of service at the hospital and I was really confused when they told me I didn’t owe them anything.</p>
<p>I’ll post again when I find out more.</p>
<p>In my (considerable) experience with ER’s, if the hospital is in network, everything else is processed as in network. You may have to make several phone calls. Usually the sticking point is how each office is coding the claims. So you may need to call each office, explain it was an emergency, and ask them to resubmit. If they give you a hard time (most are cooperative) just let them know you’ll be disputing the bill and they won’t be paid anything till they bill it properly. </p>
<p>Document all your calls, take names of everyone you speak with. </p>
<p>This is a common scenario, so you won’t be the first one to make the call. I’ve found that being very polite gets things taken care of rather smoothly. </p>
<p>And once the bills are correct, don’t hesitate to ask for a discount. It doesn’t have to be need-based. If they get paid they don’t have to pay a collection agancy fee, and will sometimes pass savings to you. </p>
<p>I recently got a $1700 (about 10%) discount just for asking, and got a nice cash back award from my credit card on the rest of it.</p>
<p>I was going to say the same thing as axw, it may be a coding error. I had that happen recently, I made a call to the insurance and doctors office, they resent it and I never heard anything after that.</p>
<p>What makes something qualify as an “emergency?” I am not familiar with the criteria for that. </p>
<p>I had bloody urine, fever, and SEVERE low back pain. I really thought it was something kidney related-- who wouldn’t? I tried to go to a regular doctor and to urgent care and they both told me they wouldn’t see me and that I had to go to the ER-- after it was discussed here I think we decided that it was because it’s necessary to rule out kidney stones or something more serious. They did a catscan and bloodwork and didn’t find anything, and the doctor pretty much came out and told me that he was stumped but that they were calling it a muscle strain for lack of any other ideas. Is that an emergency? I was completely incapacitated by pain… they ended up giving me morphine and prescribing vicodin, which made no difference in it at all, it was that bad… but it’s not like I was bleeding or something.</p>
<p>Do you have a PPO or an EPO? If you have an EPO, you don’t have any out of network coverage unless it is a certified emergency. If the ER decided it wasn’t life threatening, you would not have been eligible for in network fees for OON coverage. </p>
<p>Even so, though that still seems wrong. We discussed it here at work (I work for a group insurance broker/consultant) - apparently, it used to be common for a hospital to employ doctors who were OON and stick it to patients who had no choice but to use them - anesthesiologists were the biggest culprits. In recent years, though, the insurance companies have put safeguards in place to keep this from happening. In good faith, a hospital that is in network for your insurance should pay claims in network regardless of the doctor’s network.</p>
<p>I can’t get hold of our Cigna rep - she is in meetings. However, the suggestion from our office staff’s discussion is that you call Cigna directly and work it out with them. The coding could be wrong, or who knows what else … but if the hospital billing office says they processed it correctly, you need to talk to Cigna directly. If you don’t get good results, ask to speak to a manager. If this doesn’t work, talk to your HR office at work. I run interference for these situations all the time!</p>
<p>I have a PPO… is that good?</p>
<p>Should I call Cigna or the hospital first? Any specific questions I should ask? I always try to rehearse phone conversations a bit first because I get nervous and forget what to say… :</p>
<p>I work at a hospital and my family has used it’s services for decades.
All kinds of billing and coding issues come up.
Don’t pay the bill until you investigate it further!!</p>
<p>Take a few deep breaths, get a piece of paper and pen and jot down your questions.
Call you insurer and try to speak calmly. Listen and take notes.
IF the hospital is in network, and the visit was submitted by them as an emergency, I really, really doubt that you will owe out of network fees to the docs.</p>
<p>How would an incapacitated injured patient be able to even ASK the many many medical professionals about insurance plans while being treated in the ER?</p>
<p>Be sure to get the full name of each person you speak with and if they provide an answer you like, ask them to send it to you in writing. Actually, ask them to send ANY answer to you in writing, to confirm your conversation. Ask them to specify where in the policy they are referring to as well.</p>
<p>We were able to get S’s elective surgery with a non-participating provider paid at participating rates since the institution & surgeon were participating & we had NO idea that the anesthesiologist was NOT participating. NO ONE asked or told us anything.</p>
<p>“I just now got the bill(s), and as it turns out the hospital and the physicians have separate billing, and only the hospital participates with my insurance. So none of my physicians bill was covered at all and the cost makes me sick.”</p>
<p>Welcome to America. (Data indicate that itvcould make you physically sick as well.)</p>
<p>Yes, call your insurer first.
They are your team.
It was an emergency, as far as we all heard, first go-round. What wouldn’t be an emergency is sometimes easier to explain- if you went to ER because you had a hangnail or anything that could be delayed for a regular office visit. Or while there had someone look at your funky toenails. </p>
<p>Get this off your plate. Just call. You won’t be the first with this sort of question. Cigna can explain yor coverage, then you are armed to call the hospital and better state your position. And later, read your policy. Best of luck.</p>
<p>Ema, PPO vs. EPO: PPO allows out of network coverage, but you pay the difference between in and out of network charges (although there is sometimes a discount on the OON charge). EPO will not pay anything if you are OON, except in the case of a life-threatening emergency. PPO is “better” in that it allows you flexibility to see an OON doctor if you choose.</p>
<p>You need to call the number on your ID card. Have the bill nearby. Tell them you have a question about a bill you received. Explain that you went to the ER with (list symptoms), and that you called beforehand to make sure the hospital accepts Cigna PPO insurance. Then tell them that you received a bill for the physician charges, and the bill indicates that you had no coverage for the service. Instead, they charged you the full fee less a negotiated discount - tell them it was supposedly run through the HAP network. Ask them if this is correct. If they say it is, ask why … you want specifics. I think that you will probably find that it is not correct. Someone messed up somewhere along the line, I am guessing. If it’s wrong, ask what will be done to take care of the situation, and request an estimated date by which you can expect the situation to be remedied. Then request an email confirming the details of your discussion. If they say you aren’t covered at all, ask them to explain exactly where in your Summary Plan Description (called an SPD) you can find this information spelled out. Ask for this in writing, then take it to your HR department at work.</p>
<p>If it’s a mistake, Cigna will take care of it for you (although you do have to stay on top of it). Also, ask them to check the rest of the claim to make sure the facilities charge is correct - you can get bills 3-6 months (or more) later, so don’t think not getting any other bills yet means there won’t be any.</p>
<p>FWIW, my son used to get a high fever every time we went on vacation … and always at night, after urgent care was closed. Blue Cross denied it every single time, saying it wasn’t a true emergency. I appealed and it was paid every single time. Personally, I always thought they did it on purpose. If you deny 100 claims, I bet there is a certain percent of people who will just pay … easy way to make money.</p>
<p>You do need to call. You see, 95% of the time folks just pay the bill (even when they don’t have to). That’s part of their strategy for making money.</p>
<p>My mother was billed for ER attempts to revive my stepfather three hours after he died. Also for an ambulance trip of less than 200 yards for said dead stepfather two hours after he died. Medicare was prepared to pay it. (They weren’t told that he was already dead as a door nail.) They billed the insurance company too (in hopes of collecting double on everything.) The rule is, “Bill everything that still moves” (and maybe things that don’t), “and occasionally it will pay up.”</p>
<p>My mother also received T-Mobile bills for said dead person 90 days after he was buried, and they were informed two days after death of his demise. Most widows in their grief likely would have paid the bill. And when she called them to complain, they said they’d deal with it in the next bill. Twice. Never did of course. No supervisor at T-Mobile could “take care of it”. Finally turned over to stepbrother lawyer who “scared 'em”. Yeah, right. Just went on to billing the next dead person.</p>
<p>It’s part of what makes America great.</p>
<p>Em - It sure sounds like an emergency to me! I would have done same as you.</p>
<p>That they did that to you is crap. What a scam, I would be enraged, and I would raise holy heck. </p>
<p>I would also find out what hospital near you doesn’t pull this garbage, and will be a safe bet for you to go to in the future.</p>
<p>sounds like it would be considered an emergency, in particular because your doctor advised going to the ER, and based on the medical tests that were done at the ER, ie. cat scan. I think they will overturn this, please call and let us know.</p>
<p>Yes, esp because your doc advised it.
Kelsmom is laying it out neatly for you- suggesting an approach that will help you in many aggravating situations we all face in life. </p>
<p>I don’t think anyone needs to be enraged- and certainly not intimidated. Just approach these things logically and analytically, prepared in your own mind. These are life’s hassles. </p>
<p>As for anecdotes, my MIL used to get “renewal” notices from all sorts of organizations, posed as annual fee reminders, but received several times throughout the year. Some even from groups she never had an association with. Many, after her death. I’d call those unethical. Hospital or other billing snafus are often just mistakes. You deal with them, as best you can.</p>