- Insurance: Humana NATIONAL POS-OPEN ACCESS
- State: NC – 28110
- Details that may be relevant for negotiating bill: Mother is currently on unemployment due to job loss related to covid-19.
My father drove and admitted himself to an In-Network ER for chest pain. They determined he was likely having a heart attack and ordered him a Helicopter Ambulance to an In-Network hospital. In his medical notes under “Medical Decision Making”, the ER Doctor documented the following:
“Patient will be transported by helicopter to redacted for emergent cardiac catheterization, spoke with Dr. redacted who accepted patient.”
That night he had two stents put in to clear the 99% blockage he had in each artery. Insurance has decently covered most things however the claim for the Air Ambulance reads as follows:
- Total billed charges: $28,508.40
- Amount Humana paid: $16,489.21
- Humana discounts: $0.00
- Plan exclusion: $9,987.34
- Benefit exclusions: $9,987.34
- Your share: $12,019.19
- Applied to deductible: $1,625.65
- Copay: $0.00
- Coinsurance: $406.20
Message: This service was performed by a non participating provider. The charge amount billed by your provider exceeds the Maximum Allowable Fee (MAF). You are responsible for the difference between the MAF and the amount the provider bills you for the services.
EOB Details:
- Service Code(s): 0540
- Reason Code(s): 45/6B0
We were hopeful that the In-Network ER to In-Network Hospital would save us from the worst. What options do we have to appeal this, negotiate, etc? Any recommendations are greatly appreciated!
submitted by /u/houstonastros7878
[link] [comments]
Insurance: Humana NATIONAL POS-OPEN ACCESS
State: NC – 28110
Details that may be relevant for negotiating bill: Mother is currently on unemployment due to job loss related to covid-19.
My father drove and admitted himself to an In-Network ER for chest pain. They determined he was likely having a heart attack and ordered him a Helicopter Ambulance to an In-Network hospital. In his medical notes under “Medical Decision Making”, the ER Doctor documented the following: “Patient will be transported by helicopter to redacted for emergent cardiac catheterization, spoke with Dr. redacted who accepted patient.” That night he had two stents put in to clear the 99% blockage he had in each artery. Insurance has decently covered most things however the claim for the Air Ambulance reads as follows:
Total billed charges: $28,508.40 Amount Humana paid: $16,489.21 Humana discounts: $0.00 Plan exclusion: $9,987.34 Benefit exclusions: $9,987.34 Your share: $12,019.19 Applied to deductible: $1,625.65 Copay: $0.00 Coinsurance: $406.20
Message: This service was performed by a non participating provider. The charge amount billed by your provider exceeds the Maximum Allowable Fee (MAF). You are responsible for the difference between the MAF and the amount the provider bills you for the services. EOB Details:
Service Code(s): 0540 Reason Code(s): 45/6B0
We were hopeful that the In-Network ER to In-Network Hospital would save us from the worst. What options do we have to appeal this, negotiate, etc? Any recommendations are greatly appreciated!
submitted by /u/houstonastros7878 [link] [comments]Read Morer/HealthInsurance