Hi all,
trying to figure out what to do and if I even have any options left except paying.
I had a Empire BCBS EPO plan that is in-network only, however states that emergency treatment is covered as in network.
I was taken to Kaiser Permanente hospital in California, by ambulance after suffering a concussion (I was unconscious and don’t remember the event and most of the ambulance ride). I was checked over, not admitted and release later in the evening. I was luckily fine. But the fun was just starting.
I was billed about $28k by Kaiser, but after providing my insurance info (multiple times, I guess they lost it) I got a letter from Empire saying that they will only cover $9k (and enclosed a cheque for it). They are unwilling to cover the full amount. They don’t want to pay in full.
I’ve submitted an appeal based on the fact sheet on the DMHC of CA (https://www.dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf ) that states that the hospital and insurance company simply should not be doing this.
The appeal was “successful” and they were supposed re-process the claim, however they’ve never done that.
I’ve called, emailed and been getting a run around and nothing else.
I’ve started to message them via the portal and they’re again giving a run around.
Anyway, any experience here with dealing with this? Any tips anyone can provide?
submitted by /u/00ff00Field
[link] [comments]Hi all, trying to figure out what to do and if I even have any options left except paying. I had a Empire BCBS EPO plan that is in-network only, however states that emergency treatment is covered as in network. I was taken to Kaiser Permanente hospital in California, by ambulance after suffering a concussion (I was unconscious and don’t remember the event and most of the ambulance ride). I was checked over, not admitted and release later in the evening. I was luckily fine. But the fun was just starting. I was billed about $28k by Kaiser, but after providing my insurance info (multiple times, I guess they lost it) I got a letter from Empire saying that they will only cover $9k (and enclosed a cheque for it). They are unwilling to cover the full amount. They don’t want to pay in full. I’ve submitted an appeal based on the fact sheet on the DMHC of CA (https://www.dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf ) that states that the hospital and insurance company simply should not be doing this. The appeal was “successful” and they were supposed re-process the claim, however they’ve never done that. I’ve called, emailed and been getting a run around and nothing else. I’ve started to message them via the portal and they’re again giving a run around. Anyway, any experience here with dealing with this? Any tips anyone can provide? submitted by /u/00ff00Field [link] [comments]Read Morer/HealthInsurance