free4now
Thinks s/he gets paid by the post
- Joined
- Dec 28, 2005
- Messages
- 1,228
I'm facing a dilemna around how deep I want to get into fighting my health insurance company.
I received about $25k worth of medical care for an accident. Originally the insurance company denied about $12k worth of that because the hospital I was brought to was not a preferred provider. I filed an appeal with the insurance company asking that all care on the date of the accident be covered at 100% as if it were a preferred provider because I didn't have any choice as to where to be taken by the ambulance and it was an emergency. They granted the appeal and did go ahead and cover most all of the $25k of care (minus my deductible of course).
However there was one bill which came in late, after the appeal was processed. There was a balance of $143 on that bill after they paid the preferred provider rate, and the hospital is billing me for that $143. I submitted a second appeal with my insurance company saying that this should have been covered under the first appeal, but the insurance company's position is that their granting the first appeal was a one time favor to me, not an admission of responsibility, and they aren't interested in doing me any more favors.
What is comes down to of course is an administrative issue; the $143 was actually included in the first, granted, appeal according to my appeal text which covered all care on that date. But their computers didn't electronically link it to the first appeal because it wasn't in their system at the time. After speaking with a few insurance company reps, it seems the only way to get this resolved is for me to request an independent review by the state insurance dept of insurance. I should also carefully review my policy to see what it says about situations where I have to use non-preferred providers; I just ordered a copy of the policy for that purpose.
I don't want to be too much of a troublemaker; I don't want to get on the blacklist of people who will never be granted insurance policies on the open market, because I may someday want to get a new private insurance policy.
So I'm considering just dropping this and paying the $143 out of pocket instead of taking it to the state board. What would you do?
I received about $25k worth of medical care for an accident. Originally the insurance company denied about $12k worth of that because the hospital I was brought to was not a preferred provider. I filed an appeal with the insurance company asking that all care on the date of the accident be covered at 100% as if it were a preferred provider because I didn't have any choice as to where to be taken by the ambulance and it was an emergency. They granted the appeal and did go ahead and cover most all of the $25k of care (minus my deductible of course).
However there was one bill which came in late, after the appeal was processed. There was a balance of $143 on that bill after they paid the preferred provider rate, and the hospital is billing me for that $143. I submitted a second appeal with my insurance company saying that this should have been covered under the first appeal, but the insurance company's position is that their granting the first appeal was a one time favor to me, not an admission of responsibility, and they aren't interested in doing me any more favors.
What is comes down to of course is an administrative issue; the $143 was actually included in the first, granted, appeal according to my appeal text which covered all care on that date. But their computers didn't electronically link it to the first appeal because it wasn't in their system at the time. After speaking with a few insurance company reps, it seems the only way to get this resolved is for me to request an independent review by the state insurance dept of insurance. I should also carefully review my policy to see what it says about situations where I have to use non-preferred providers; I just ordered a copy of the policy for that purpose.
I don't want to be too much of a troublemaker; I don't want to get on the blacklist of people who will never be granted insurance policies on the open market, because I may someday want to get a new private insurance policy.
So I'm considering just dropping this and paying the $143 out of pocket instead of taking it to the state board. What would you do?
