Posts
3608
Joined
6/9/2009
Location
Aliso Viejo, CA
US
Will probably end up in non moto but I’ll start here.
I have a pretty decent med insurance plan but In an emergency situation I was brought to an out of network medical provider and once stabilized thransferred to an in network provider. Long story short after spending 3 nights in the non network hospital and am left with a pretty hefty bill. I have met all of my max out of pocket deductables for the year and appealed 3 times the remaining balance with my provider to only be denied. They said they have paid all they are going to pay for services rendered. (Reasonable amount for services). However, the hospital is charging what seems to be a pretty inflated rate and I am being told that I am resposible for the difference above and beyond my max out of pocket deductables. I have also read that balance billing is illegal in the state of California. If you have any info that you can share on how to handle it will be greatly appreciated.
Thanks,
Ryan Raiford
I have a pretty decent med insurance plan but In an emergency situation I was brought to an out of network medical provider and once stabilized thransferred to an in network provider. Long story short after spending 3 nights in the non network hospital and am left with a pretty hefty bill. I have met all of my max out of pocket deductables for the year and appealed 3 times the remaining balance with my provider to only be denied. They said they have paid all they are going to pay for services rendered. (Reasonable amount for services). However, the hospital is charging what seems to be a pretty inflated rate and I am being told that I am resposible for the difference above and beyond my max out of pocket deductables. I have also read that balance billing is illegal in the state of California. If you have any info that you can share on how to handle it will be greatly appreciated.
Thanks,
Ryan Raiford
https://www.npr.org/sections/health-shots/2018/08/27/640891882/life-thr…
Also, talk to a patient advocate at the hospital. They may be able to help you with this process.
I have a feeling that since you have met your max out of pocket, you can force your insurance to pay the hospital. It's up to them to hash out how much the fees should be; not your problem anymore.
Don't just "appeal." That's like asking, "pretty please?" If they are contractually obligated to pay, don't give them one inch.
I am 100% convinced that insurance companies have people whose entire job it is to deny perfectly legitimate claims so the company earns more margin.
The Shop
I hope this doesn't sound callous, but I'm actually glad you were on drugs when they took advantage of you.... this is an ace up your lawyer's sleeve, should it come to that. I think you have a good case. Don't feel bad about going toe to toe with the insurance company; they truly do not have your best interests at heart, no matter what fluff goes out in their feel-good marketing.
All those uninsured people waiting in then ER, that's how the hospitals make their money back... charging insurance exorbitant amounts and people like you and me that are trying to do the right thing and maintain a credit score.
I am having arhtroscopic Procedure and my neighbor warned me that watch out for the anesthesiologist and make sure he is in network also . If not I would be paying for it . Just an example.
Until they figure out health insurance isnt about healthcare, nothing will change.
Their welfare people have 100% coverage and never see a bill. Not even for 1 cent. Their system is ass backwards.
Pit Row
You also have to understand, there arent many hospitals that can handle major things, so travel may be necessary. The whole country has less people than California, so there isn't major centers on every corner filled with snot nosed welfare kids billing the hell out of the government. I went to the local hospital with a compound clean break Tib/Fib and was out in 3 hours total. Good to go.
I have relatives in the US that have surguries scheduled for 6 months out. Soonest they can get in within a 12 hour drive. Oh, and the closest doc to them that takes their insurance is 6 hours away, which will take new patients.
Their regular doc is booked out.
So for all the medical centers in the US and urgent care facilities on every corner, your system is probably worse
First question you ask is...is this in network? And I need to speak with a social worker before I agree to receive treatment.
You need a letter from the treating physicians to state it wasn’t feasible to transport you. They’ll write this letter, you gotta ask them.
I’d go hard at that insurance company. But go through your plan with a fine toothed comb. Or a highlighter. All 50 pages of course....
If All else fails.....you call the hospital and start negotiating. They might wipe majority of the bill and set you up with an interest free payment plan.
If you’re still not happy lawyer up. But....you’re probably more apt to beating it with physician letters, not subpoenas.
You are paying plenty for your healthcare via taxes..far more than you’re getting benefit from. In fact, I’d be willing to bet the OPs bill for his ankle ( plus his premiums ) are going to be significantly less than you paid for your health insurance this year..
Best of luck man. The out of network thing is bullshit. Nothing like getting an extra expense because you needed immediate treatment.
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