I had an accident last year where I fell while surfing, and landed face-first on my surfboard. The point of contact was my eyelid, and the vision in my eye went immediately – I couldn’t see anything other than a fog of grey and yellow. It opened up a large gash on my eyelid that start pouring blood all over my face. This was over a weekend, and even though we were tempted to try to find an urgent care (despite the fact I was freaking out at my loss of vision – I just always prefer urgent care since it’s more affordable) the one we went to was closed. Normally I would go to urgent care for a cut or injury, but the fact this was on my eye and my vision just went had me really worried. So we went to the ER after all – they were able to stitch it up for me and my vision gradually came back. I did ask both the doctor and the admitting nurse whether urgent care would have been able to handle the injury, and they both said no – given the location on my eye they said there was no other option than the ER.
Fast-forward to now and our insurance is denying the ER claim. I’ve called them multiple times, and no one can tell me why they have denied it, by all our plan paperwork it is supposed to be covered. I’m assuming the next step is to appeal this, but how do I appeal effectively without knowing the reason it was denied? Is there anything else I can do in the meantime?
Thanks very much for any advice!
submitted by /u/surfergirl100
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I had an accident last year where I fell while surfing, and landed face-first on my surfboard. The point of contact was my eyelid, and the vision in my eye went immediately – I couldn’t see anything other than a fog of grey and yellow. It opened up a large gash on my eyelid that start pouring blood all over my face. This was over a weekend, and even though we were tempted to try to find an urgent care (despite the fact I was freaking out at my loss of vision – I just always prefer urgent care since it’s more affordable) the one we went to was closed. Normally I would go to urgent care for a cut or injury, but the fact this was on my eye and my vision just went had me really worried. So we went to the ER after all – they were able to stitch it up for me and my vision gradually came back. I did ask both the doctor and the admitting nurse whether urgent care would have been able to handle the injury, and they both said no – given the location on my eye they said there was no other option than the ER. Fast-forward to now and our insurance is denying the ER claim. I’ve called them multiple times, and no one can tell me why they have denied it, by all our plan paperwork it is supposed to be covered. I’m assuming the next step is to appeal this, but how do I appeal effectively without knowing the reason it was denied? Is there anything else I can do in the meantime? Thanks very much for any advice!
submitted by /u/surfergirl100 [link] [comments]Read Morer/HealthInsurance