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LIMOMx2
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Member since 5/05 24989 total posts
Name:
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Our Insurance Co is not paying DH's ER bill...
Because they do not think it was an emergency!!! WHAT!!!!!! My DH thought he was having a heart attack His blood pressure was sky high, he was dizzy and he was nauseous.
Now he has been on blood pressure ever since this incident.
How can they say that they don't consider that an emergency and just deny it!!!!!! The hospital said this is really rare. We have to appeal it but in the interim we will be sent to collections because I am not paying it!
HOW ANNOYING!!!!!!!! 
Vent over
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Posted 6/30/08 12:08 PM  |
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Long Island Weddings
Long Island's Largest Bridal Resource |
neener1211
:-)
Member since 4/07 22952 total posts
Name:
J
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Re: Our Insurance Co is not paying DH's ER bill...
Is it possible that the Insurance company doesn't have all the information from the hospital?
I had gotten a letter saying our Ins. company was denying our stay in the hospital for giving birth!! They said it was not medically necessary. Turns out, they had not contacted the hospital for why I was admitted.
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| Posted 6/30/08 12:43 PM |
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LFitzy79
can hardly wait
Member since 5/05 2650 total posts
Name:
Lauren
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Re: Our Insurance Co is not paying DH's ER bill...
I don't think they can send your account to collections if you're resubmitting the claim....I'd call the NYS insurance board if I were you.
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| Posted 6/30/08 12:44 PM |
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MST9106
My life:)
Member since 6/06 9589 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Definitely resubmit the claim and doctor's supporting documentation of his high blood pressure condition. Fight it!
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| Posted 6/30/08 12:46 PM |
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MrsMessina
Thankful for our miracles!
Member since 2/07 7254 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Posted by LFitzy79
I don't think they can send your account to collections if you're resubmitting the claim....I'd call the NYS insurance board if I were you.
I agree- I called about a bill that we got from the hospital for DH and the hospital told me they would mark it in the account not to put it through to collections for another 30 days until this was all resolved.
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| Posted 6/30/08 12:48 PM |
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anonttcer
BOOOO for fall!
Member since 7/06 10082 total posts
Name:
Meaning a NON ttcer!
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Re: Our Insurance Co is not paying DH's ER bill...
These insurance companies truly disgust me!!
They charge you through the nose for this insurance (whether it be car, home owners, health) and the second you want to use it- they give you a hard time!
What do they think? That he just felt like going to the ER for sh!ts and giggles?
Hey I'm bored- I think I'll hit up the ER today.... 
All so the executives can get big fat paychecks....
Disgusting!
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| Posted 6/30/08 12:49 PM |
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neenie
Member since 5/05 22351 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Does he have Magnacare? (they do that alot).
You can appeal that with medical records (or the hospital and/or Dr. can appeal it for you). They'll most likely pay it in the end.
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| Posted 6/30/08 1:02 PM |
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ave1024
I Took The Wrong Road
Member since 12/07 6153 total posts
Name:
That Led To The Wrong Tendencies
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Re: Our Insurance Co is not paying DH's ER bill...
Posted by LFitzy79
I don't think they can send your account to collections if you're resubmitting the claim....I'd call the NYS insurance board if I were you.
They can send the account to collections as they see fit. It doesn't matter if you are resubmitting the claim or not.
Just dispute the collection the right way. Demand validation of the debt.
How long ago was this ER visit? I monitor my insurance claims online to make sure they get paid. This way I don't get slapped with a surprise 6 months after any visits when the HMOs are in the right to send the account to collections.
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| Posted 6/30/08 1:04 PM |
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neenie
Member since 5/05 22351 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Posted by LFitzy79
I don't think they can send your account to collections if you're resubmitting the claim....I'd call the NYS insurance board if I were you.
Yes they can. Calling the state isn't really going to do much for the status of the bill right now- that's more for fraudulent activity...
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| Posted 6/30/08 1:07 PM |
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Beth
The Key to your new home....
Member since 2/06 24849 total posts
Name:
Beth
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Re: Our Insurance Co is not paying DH's ER bill...
I am dealing with the same thing
I was told the hospital didn't submitt any info other then observation
which is not covered under my plan either- I hope they cover it
I refuse to pay the $1K
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| Posted 6/30/08 1:12 PM |
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MrsPJB2007
MBA at your service!
Member since 7/06 12020 total posts
Name:
MJ
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Re: Our Insurance Co is not paying DH's ER bill...
my insurance company did the same thing to me once---but then my regular doctor informed them that it was in fact an emergency and they paid for the ER visit
talk to your regular doc and have him tell the insurance it was an emergency. sometimes they don't consider it an emergency unless your regular doc was notified before you went to the ER.
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| Posted 6/30/08 1:12 PM |
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fins
LIF Adolescent
Member since 9/07 821 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Call your insurance company. I used to handle employee benefits and we had Vytra for our insurance. They were always denying er visits. (and we were employees of a hospital. Most of the people we covered were knowledgeable about what would require ER treatment, infants with fevers, allergic reactions to medicine during non business hours, etc.).
We constantly would have to fight with claims and they would then pay the claim. Annoying, but we almost always were able to get it paid.
In the state of NY, for insurance if a prudent layperson believes it is an emergency, the insurance co. is supposed to pay the claim as an emergency.
If a "prudent layperson" thought they were having a heart attack that would be an emergency.
This is from the NYS bill of rights for Health Insurance customers.
You have the right to access emergency services 24 hours a day. By law, a situation is considered to be an "emergency" if a prudent layperson believes that failing to act immediately would put your health or the health of others in danger.
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| Posted 6/30/08 1:31 PM |
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MarisaK
HELLO Manolo !!
Member since 5/06 14562 total posts
Name:
Marisa
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Re: Our Insurance Co is not paying DH's ER bill...
Did the hospital submit the claim/bill correctly (correct diagnosis codes and all that?) -
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| Posted 6/30/08 1:49 PM |
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LIMOMx2
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Member since 5/05 24989 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Posted by neenie
Does he have Magnacare? (they do that alot).
You can appeal that with medical records (or the hospital and/or Dr. can appeal it for you). They'll most likely pay it in the end.
OMG> Yes we do!!!
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| Posted 6/30/08 1:56 PM |
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neenie
Member since 5/05 22351 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Posted by 5ofClubs
Posted by neenie
Does he have Magnacare? (they do that alot).
You can appeal that with medical records (or the hospital and/or Dr. can appeal it for you). They'll most likely pay it in the end.
OMG> Yes we do!!!
Then you should be fine. Just have them appeal it with the medical records. I really think Magnacare's system is set up to automatically deny every claim at first b/c that's their standard denial! 
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| Posted 6/30/08 1:58 PM |
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LIMOMx2
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Member since 5/05 24989 total posts
Name:
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Re: Our Insurance Co is not paying DH's ER bill...
Thank you everyone. I never thought about talking to DH's Primary about it. He is the one that had to put DH on medicine right after the ER visit.
It is so frustrating.
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| Posted 6/30/08 1:58 PM |
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