So my son broke his arm last year and we took him to the emergency room. The doctors inserted a pin into his arm to help with the healing, because the break was above the elbow.
The insurance company has denied the claim, as something that’s not covered. The specific procedure code is 24538.
The hospital has appealed the denial 2 times claiming it’s medically necessary, but after the two denials, they’re done trying. I talked to them and they’re like, “Well we shouldn’t be responsible to pay. Customers should know what’s covered and what’s not covered and refuse any treatment that isn’t covered.” (Which I think is completely unreasonable, especially considering the situation.) The hospital never warned us that the procedure might not be covered, or asked us to make sure to get approval or anything. They told us it was necessary and we believed them.
Is it time to get a lawyer? Do I go to HR (it’s employee insurance)? Go to the local news and make a stink? Am I just SOL and shouldn’t bother? Because I’m worried getting a lawyer, or whatever might end up costing more than the bill, which is only like $2,900.
I remember reading something about how if a hospital does a procedure and they don’t get pre-approval, then they’re on the hook. But apparently that’s not how his hospital sees it.
submitted by /u/EpOxY81
[link] [comments]So my son broke his arm last year and we took him to the emergency room. The doctors inserted a pin into his arm to help with the healing, because the break was above the elbow. The insurance company has denied the claim, as something that’s not covered. The specific procedure code is 24538. The hospital has appealed the denial 2 times claiming it’s medically necessary, but after the two denials, they’re done trying. I talked to them and they’re like, “Well we shouldn’t be responsible to pay. Customers should know what’s covered and what’s not covered and refuse any treatment that isn’t covered.” (Which I think is completely unreasonable, especially considering the situation.) The hospital never warned us that the procedure might not be covered, or asked us to make sure to get approval or anything. They told us it was necessary and we believed them. Is it time to get a lawyer? Do I go to HR (it’s employee insurance)? Go to the local news and make a stink? Am I just SOL and shouldn’t bother? Because I’m worried getting a lawyer, or whatever might end up costing more than the bill, which is only like $2,900. I remember reading something about how if a hospital does a procedure and they don’t get pre-approval, then they’re on the hook. But apparently that’s not how his hospital sees it. submitted by /u/EpOxY81 [link] [comments]Read Morer/HealthInsurance