I received a terrifying letter yesterday.....UPDATE! OVERTURNED!!!!!

[ChicknThief]

Ok, so a couple of months ago I had an infection, and I bought a generic version of Monistat, called Miconizole. Within 15 minutes of using the medication I was on the floor, writhing in pain. I couldn't stand, couldn't talk, and could barely breathe it was so intense. My mom is a nurse, so I called her and managed to explain what was going on. She told me to get in the shower and wash the medicine out. The relief was immediate, but not complete. And within about 30 minutes, the pain was back. Jamison begged me to go to the ER, but I kept refusing. Finally after two hours, the pain had returned to intolerable levels and I agreed that an ER trip was necessary.

Once I was admitted, I kept trying to explain to the ER doctor what had happened. I even brought the medication's box with me. But he wouldn't look at the box and refused to discuss it with me. He dismissed it as completely irrelevant, even though it was the entire reason we were there. He gave me some pain killers and 6 unidentified pills that he had me take all at once. Whatever they were, they worked, and the pain/irritation was gone within about a half hour.

We finally got home at about 4 in the morning, and we thought the whole ideal was over. Until yesterday. Jamison went to go get the mail, and he brought back a really thick letter from Sutter Select, my insurance provider. I thought it was just one of their surveys that they send out periodically, and I almost tossed it aside. I changed my mind and opened it up....

Dear Jessica ******,

Sutter Select has informed us that they have DENIED your claim as a Non Emergency. They will not process this claim for 1,526.21$. You have 14 days to respond before this balance is transferred to you to pay privately.

Thank you for your cooperation

Attached were several pages detailing exactly what I was being charged for along with a letter I could attach a check to and send back. Jamison saw the dumbstruck look on my face and took the letter. We sat in silence together for a couple of minutes before I finally just burst into tears. I have been working so hard, for so long, to get out of debt. I sacrificed my independance for six months even, moving back in with my Dad and Stepmom so I could save some money and drag myself out of my pit. And I had finally succeeded. In fact, I only have a couple hundred dollars left to pay off. I was so close. And now this. I am devastated.

I am going to call on my lunch break today and see if I can get this overturned. I certainly hope so. I don't see how what I was experiencing could be construed as anything BUT an emergency.

Edited to Remove an insensitive and ignorant comment made in frustration and anger. I apologize to any I may have offended. I love you guys​

 

[aoxa]

I'm very sorry.. That really sucks..

I have never had to deal with this, but I know that your medical system really needs to be improved.

All I can say is to fight for what you think is right. Maybe you can get them to change their mind? I have no idea how it works in the US though. I don't have to pay for any medical care here in Canada.

 

[ChickiKat]

I would challenge it, most insurance companies have a certain number of claims that they deny at first presentation.

 

[aoxa]

Quote:
I remember seeing that on Sicko (movie).

 

[EweSheep]

Oh you got to me kidding me!!!!!

Did they say WHY they are denying the claim????

(I used to be a health insurance claim processor/adjustor for a welfare trust fund. Personally, I would have NOT denied THAT type of claim, accidental or not.)

Appeal the denial, most of the time it would override. Happens all the time.

 

[Sonoran Silkies]

You need to get copies of the medical reports and ITEMIZED billing, and read through them with a fine-tooth comb. You are looking for several things:
1) to verify if the billing information is correct--studies have shown that a huge portion of hospital bills contain errors in the charges.
2) check the medical codes listed on the report and on the claim sent in to the insurance company. Are the codes the same, and are they accurate for your condition? You will probably have to do a bit of reasearch as the codes are numeric, so not obvious from looking at them.

You need to write a letter to your insurance company asking why they have denied the claim (a call first might be useful, although time-consuming, but would give you specifics to address). You may have to provide more information to them, letters from the staff that attended you, letters from your husband and from your mother. Anyways, you need to verify that they did indeed deny the claim, and why, and then formally protest their denial.

Also, even if it was a non-emergency, they should have covered a portion of the claim.

In the meantime, contact the hospital and let them know that you are protesting the claim, and expecting that your insurance will eventually cover it. Ask them how to proceed as you are unable to pay it all at once, and have every expectation that a large portion, if not all, will eventually be covered.

 

[Ksane]

Quote:
Explain this part to me. We have no insurance and my husband went to the ER a month ago (seizures in the middle of the night-scary) and we got a bill for over $1600 that we're going to have to pay off for the next couple yrs. No one told us it was free if we didn't have insurance so I don't quite understand what you mean. I'm truly curious, not being argumentative in any way at all. I sympathize with you.

 

[EweSheep]

Quote:
2x

What I do find errors, are the CPT codes, DX codes don't match or providers didn't accurately put the correct DX code WITH the CPT codes. If you see the itemized bill and if it says NON EMERGENCY ER visit, then you got a valid point that it was an emergency.

Medical reaction is an emergency and in your case, it is justified. Like Sonoran said, call your insurance claims, get the processor and their supervisor if necessary to hear what you are presenting. If they tell you its the hospital and it is what they billed them, then you need to call the hospital ASAP!

Check and recheck your billing statements, EOBs and all that jazz.

 

[ChicknThief]

Quote:
I have always been told that if a person doesn't have insurance and they go to the ER, that they don't pay out of pocket. That it goes to the taxpayers? Though from the sound of your story, it seems that my information is incorrect. And re-reading it now that I am calm, it was grossly insensitive and ignorant. I am so sorry. I am going to go back and edit that.

 

[EweSheep]

Quote:
I have always been told that if a person doesn't have insurance and they go to the ER, that they don't pay out of pocket. That it goes to the taxpayers? Though from the sound of your story, it seems that my information is incorrect. And re-reading it now that I am calm, it was grossly insensitive and ignorant. I am so sorry. I am going to go back and edit that.

Only if you have Medicaid. Otherwise payment plan may be the direction to go IF you dont' fight it/appeal it to get them to pay.