DD went to the ER for an emergency. She was admitted to the hospital less than 30 hours later.
The surgeon who admitted her said they should never have let her leave the hospital.
Our insurance waived the ER copay if admitted within 24 hours. We disputed the charge and the insurance company waived it.
The ER doc, it turned out, was not a participating doc in our plan. I very politely called the insurance company (my policy and I had DDs permission to chat) and said “when you are in the ER, are you supposed to ask the doctor in your cubby whether they participate in your insurance plan? And if they don’t…do you ask for a different doctor?” Company decided I was right and waived the out of network charges.
You know…there is a lack of common sense in some of this. I mean really…in the ER…are you supposed to ask the doc if they take your insurance plan? Most docs wouldn’t know anyway.
But back to RX coverage…I’m still trying to figure out why my generic copay is $5, but I had one generic for $3 and change and another for $6 and change. That makes no sense.