General Question

pattyb's avatar

Medical Insurance not paying for an Emergency Room visit!

Asked by pattyb (786points) July 9th, 2008 from iPhone

Got sick. Real sick. Lots of pain. Trouble breathing. Lots of phlem(sp). Can barely move. Cant swallow so can’t drink, dehydrated. Dry heaves. Go to emergency room for help, cause it felt like I was dieing . Told “you have a bad flu, go home”. Insurance Co.(a big one) says ” not an emergency, we will not pay” stuck with $800 bill. What can I do to rectify the situation. What would you do?

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3 Answers

shilolo's avatar

First, look at your insurance policy and see what it says specifically about emergency room visits. My experience is that there is always some deductible, but if you are admitted to the hospital that goes away. Sometimes they expect you to call first (like a 24h nursing hotline) to get clearance (even though this seems lame). Perhaps the person you spoke to is misinformed, and more importantly, if you have the policy to back you up, you can correct the mistake. I would also move up the chain of command and ask to speak to one supervisor after another. It is not uncommon for the lower level workers to deliberately annoy/harass/frustrate you so that you pay the claim rather than the insurance company. Remember, the squeaky wheel gets the grease. Good luck.

ava's avatar

It’s a conspiracy, damned those Insurance companies!!!

scamp's avatar

Appeal it until they pay! Let me guess, the company’s name begins with an “A”, right? I did the insurance work at my last job. If I can help, Feel free to send me a private comment.

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