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11/30/2009 08:57 AM

I need OT help RE insurance

blazyn
blazyn  
Posts: 263
Member

editing since I received info I needed - thanks!

Post edited by: blazyn, at: 12/03/2009 08:03 AM

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11/30/2009 09:50 AM
newrsd
 
Posts: 1076
Senior Member

I would say if they really didn't do any care for you, you can fight it. If they even took records, or did a minimal exam, they will consider it an ER visit.

It stinks, but not much you can do about it except hope for good luck with your insurance company.

I used to do medical billing and not everything is just which insurance comp. do, but hard to fight city hall. You can always apply for financial assistance for your co pay and hope that you get it.


11/30/2009 11:05 AM
blazyn
blazyn  
Posts: 263
Member

Thanks for the reply. I saw no one other that the receptionist, the charge nurse, and the registration person (I guess it would have been considered triage for billing purposes). I talked to NO one, SAW no one except those three people, left, got the bill, called my insurance company and told them to get their money back from the hospital a few months back when this was all fresh in my mind. I hate that hospital - I've never been there and I'll never go back. I edited a lot of what the nurse said, but I've NEVER been talked to like that by anyone in any kind of field of dealing with people, let alone dealing with people in pain 24/7 in a hospital. I wish I'd gotten that person's name, I'd have lodged a formal complaint - I was in such hysterics from how I was treated I almost passed out my doctor was really worried about me.

But this health care system is amazing, isn't it? LOL Ahh the stories I'll bet we all have. But again, thanks for the response. I'll bet this will come back and bite me in my tush - things like this normally seem to have a way of working that way.


11/30/2009 01:07 PM
fluffyluggage
fluffyluggage  
Posts: 4722
VIP Member
I'm an Advocate

Hey Blazyn,

Did ANYONE take you back to take your vitals? Remember back and figure this much out. If you weren't triaged, which means: if you weren't take back AT ALL, and your vital signs weren't checked, then you weren't seen for any purposes whatsoever. Just the fact that you were checked into the ER doesn't mean squat!

Now, usually with insurance, they do require you to call them when you go to the ER, because if you need to be admitted, there's a different co-pay. However, if you aren't, then the co-pay is higher. But regardless, if you weren't actually triaged at all, your vitals weren't taken, then they can't bill you whatsoever, and you should be able to file whatever you need to against this, and you should have no problems winning.

If your vitals were taken, then it's often considered the start of an ER visit, and then fighting it can get a bit trickier. That doesn't mean I wouldn't still fight it! I'd still fight it like a bastard if I were you! You weren't seen by the doctor, and by all rights, you shouldn't have to pay. I have seen some medical records get fibbed--not saying anything against anyone in particular, but I've seen it happen--that a patient was seen and left AMA, so that the medical records could be written up and the hospital could get paid. Now, that doesn't mean that happened in this situation--it could just be that they are hoping you will just pay the bill and shut up! But I would really fight this one, especially if you never had your vitals taken!!

Hope this helps some!

Hugs,

jen Smile


11/30/2009 07:11 PM
Allym
Allym  
Posts: 79
Member

Hi Blazyn, I work in the health care field. First your need to request an itemized bill for "services received" with all of the codes they used to bill your insurance then you can fight it if you did not receive any care other than a RN coming out to yell at you. You will probably have to go into the hospital and sign a release form for medical records to give this info to you. Then call your insurance and request the same thing from them to see what was actually billed them. Then take these records to accounts payable or billing department at the hospital and ask to speak with the director and let them know you didn't receive any services and you will lodge a complaint with the state and also JACO which is the governing board for hospitals if they bill this to you and also your insurance as that is fraud- if you actually didn't receive any treatment and only sat in the wait room you should not have been billed for any services. You should also file a complaint with the director of nursing at that hospital in writing-with as much detail and description of the nurse who was abusive to you as you can.

Take someone with you when you go to talk to them so you will have a witness. These are all of my suggestions. Hope they are helpful!


12/01/2009 05:34 PM
fluffyluggage
fluffyluggage  
Posts: 4722
VIP Member
I'm an Advocate

Allym,

Awesome advice! My mom was a nurse, and I worked in the medical field, but fortunately, I worked with pets--didn't keep me from dealing with humans, but it did keep me from dealing with insurance! It's good to know from the medical billing aspect EXACTLY what to do, who to go to, and where to send all the info. I'll definitely come to see you the next time I need to fight a bill I don't owe! LOL

Hugs,

jen Smile


12/01/2009 07:17 PM
Allym
Allym  
Posts: 79
Member

Anytime, I am happy to give input and glad I can use my experiences to help others that aren't as familiar with walking thru the landmines of negotiating insurance and billing...

12/03/2009 07:33 AM
fluffyluggage
fluffyluggage  
Posts: 4722
VIP Member
I'm an Advocate

In fact, I may be seeing you very soon... I'm about to be fighting a PT bill. Will let you know what's going on this afternoon, perhaps! Argh!

Hugs,

jen Tongue


12/03/2009 05:55 PM
Allym
Allym  
Posts: 79
Member

hmmm so how did it go?

12/04/2009 07:52 AM
blazyn
blazyn  
Posts: 263
Member

I did my initial claim on the phone and I got a response in the mail (which is what I posted about) saying I had 90 days to submit a written appeal. Meanwhile I have the hospital calling me wanting their money so I told them what happened, so I guess they're putting it off for the moment? I have my appeal, just need to print and send out. I hate dealing with insurances. Most of the time I never bother because what's the point, you can never really win :/
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