Insurance: Community Health Choice (Marketplace plan)
I met my OOP Max on January 2, 2022. A few days later, my worried neighbor called an ambulance and EMS took me to the ER. I think HFD responded, but I never saw the vehicle, so I’m not 100% sure.
EMS providers in the Houston area do not contract with my insurance (iirc HFD specifically is prohibited from insurance contracts). Also, it’s my understanding that ground emergency transportation providers are exempt from the ban on balance billing.
My plan does not have coverage for out-of-network providers. However, my insurance plan summary indicates that emergency medical transportation is of no cost to me after my deductible is met, regardless of provider network status (no differentiation for air vs. ground).
In the off chance that the ambulance ride is of no cost to me, does my plan end up paying the full $2000+ for the services provided, or do they negotiate with HFD for a rate closer to UCR?
If the two entities disagree, am I stuck paying the difference, given the legislative exception for ground emergency transportation?
I think my insurance plan document has a typo. I am fully expecting to receive an EOB stating “no coverage for non-network providers” and a $2000+ bill from HFD. If that happens, do I have any recourse with the insurance company?
submitted by /u/mhmthatsmyshh
[link] [comments]Insurance: Community Health Choice (Marketplace plan) I met my OOP Max on January 2, 2022. A few days later, my worried neighbor called an ambulance and EMS took me to the ER. I think HFD responded, but I never saw the vehicle, so I’m not 100% sure. EMS providers in the Houston area do not contract with my insurance (iirc HFD specifically is prohibited from insurance contracts). Also, it’s my understanding that ground emergency transportation providers are exempt from the ban on balance billing. My plan does not have coverage for out-of-network providers. However, my insurance plan summary indicates that emergency medical transportation is of no cost to me after my deductible is met, regardless of provider network status (no differentiation for air vs. ground). In the off chance that the ambulance ride is of no cost to me, does my plan end up paying the full $2000+ for the services provided, or do they negotiate with HFD for a rate closer to UCR? If the two entities disagree, am I stuck paying the difference, given the legislative exception for ground emergency transportation? I think my insurance plan document has a typo. I am fully expecting to receive an EOB stating “no coverage for non-network providers” and a $2000+ bill from HFD. If that happens, do I have any recourse with the insurance company? submitted by /u/mhmthatsmyshh [link] [comments]Read Morer/HealthInsurance