Background: On a Friday in September, I started feeling what felt like zit on the inside of my nose, which was strange, because after being on Accutane for 8 months, I don't get zits anymore. By Monday, my whole nostril was red and swollen. So I went to my dermatologist. He said it was an infection of some sort, gave me an antibiotic and told me to come back on Wednesday if it wasnt getting better.
Well, by wednesday, it was NOT better. so I sent in to see him and he looked at it again and said that I needed to go to the ER to get IV antibiotics. The pill wasnt getting the medicine to my system fast enough.
Fair enough, I trust my doctors opinions. So I go. and I sit, and I wait in the waiting room. And finally they get me back there and the doctor takes one look at me, says "eh, it's a staph infection. you dont need an IV. We'll just double your dose of pills to knock it out and you'll be good to go."
um...okay?!?
Soooo, ER doc gave me a prescription for yet another pill and sent me home.
A couple of months ago, I got a notification from my insurance company that they had declined to pay the ER or Physicians bills for the hospital because their review of the situation determined that it was unnecessary for me to go to the ER. Well, sure. If I had known it was just going to be another pill, my dermatologist could have prescribed that. But HE wanted me to get an IV, and the ER had other plans. Therefore, since the hospital did not follow the recommendations of my dermatologist, which resulted in my insurance company declining the bill, who got stuck with it?
Yours truly.
How the hell was I supposed to know that would be the outcome? Thank you, health care industry. You suck. Oh wait, I haven't paid you yet. Aaaaaaand, I don't intend to. I'm gonna wait long enough that you'll be happy to get something out of me, and when I'm satisfied that it's low enough I'm willing to pay, or I'm abundantly rich and can afford it to make you go away, I'll pay it then. But for now? No way. Your screw up for not following doctors orders. I'm not using my $1000 emergency fund to pay for this, and I have other bills that are more important, and I need to save that money for a true emergency. It's just going to have to wait.
1 comment:
Ok....health insurance lady to the rescue. Try not to hate the insurance people too much (at least me). We do our jobs the best way we can with the parameters set forth by years of precedent and government regulations. Despite popular opinion (and the jab regarding evil insurance company's in the State of the Union last night) we do NOT all role in dough. Unless, say, you are UHC, Blues, Aetna, and Cigna, but I digress. No politics here....=)
Amanda, I know the stubborn streak in you is in hyper drive (how long have I known you again?), but if you are willing to take a few steps and make a few phone calls, then you may be able to come away with not paying a settlement either.
First, did your Derm give you any paperwork, etc directing you to the ER? If not, can you obtain a copy of your medical records for that date of service (DOS) showing their recommendation to the ER in your medical notes for IV antibiotics. NOTE: Some offices will want to charge you for the medical notes. If you are requesting one DOS, you should be able to get them without cost, especially if they have electronic medical records...then it just requires them to hit print. Paper records and can a little longer to pull, but still it isn't too difficult. If you get push back, go directly to the office manager (OM) and have a discussion. OM's are generally nice people, though very busy. The Derm has been paid I assume, so they shoud be happy to help you get the notes.
Once you get the med notes, hopefully they state they sent you to the ER. They should as that was part of your visit notes. If they do, then you should be able to contact your insurance Customer Service number and request reconsideration. It will most likely require a fax of the med notes, a copy of the bill (preferably without the additional text) and a letter from you stating what the issue is. I recommend you ask for a supervisor, but be ready to at least triage the issue with the initial CS rep and them provide you an option. You may have to push for a supe, but they will know what reconsideration options there are out there that they don't publicize openly (they do exist).
You may have to push...but it is usually met with success. Example, it has taken me THREE years to get Aetna to pay for claims from Eric's car accident. Granted I wasn't privy to them until later, but by God that was over $2000 that he doesn't have to pay!
Ins co's have ER diagnoses that auto deny as people do take severe advantage of the ER (I'm talking about people with insurance, not people without), but if you provide documentation of being sent to the ER and push hard enough you should be able to get by with your ER member responsibility only (copay, ded, whatever).
If you need help, you just let me know. Ok....insurance lady has now left her office. =) HAHA!
-Patsy
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