I am in need of major help from anyone who has dealt with an out-of-network insurance/emergency surgery.
For context, I am 24, still on my mom’s insurance, Amerihealth. My parents live in Pennsylvania, but I moved to Virginia for a job opportunity. It has been hard to find in-network doctors in my area for normal health visits, but this has totally overwhelmed me.
Plan Details:
I make around $30k/yr before taxes. Deductible – Individual: $250 / Family: $500. Out-of-Pocket Maximum (applies to in-network medical and RX expenses only) – Individual: $8,550 / Family: $17,100. Surgical Services and In-patient Hospital Services – $0 after deductible. Hospital ER: $100 / visit (waived if admitted). I believe the premium is $168.50
The Situation
Back in October, I had bad pains in my stomach. I left work early and suffered through the night before going to the only Med Express in my area the next morning when they opened. They believed it had something to do with my appendix and called the closest emergency department and hospital letting them know I was coming.
After the hospital ran scans on me and decided I needed an appendectomy, I was under anesthesia in the operating room 30 minutes later. I received an appendectomy and was discharged from the hospital all in one day.
Even though this was an emergency surgery and there was no “in-network” hospital within at least 100 miles, Amerihealth is not covering the entirety of the surgery. The cost is over $21,000. Amerihealth says they have an allowed amount of about $7,800 and paid the hospital, but a balance of over $14,000 still remains.
It looks like I am going to have to begin an appeal to fight for Amerihealth to cover the insurance. The hospital has already told me that they do not file appeals on behalf of patients. I am very overwhelmed with them only paying for 1/3 of the surgery. I would appreciate any advice on how to handle this situation, successfully write an appeal, or any feedback from someone who has appealed coverage by Amerihealth.
Thank you so much for your time and consideration!
submitted by /u/Front-Log5205
[link] [comments]I am in need of major help from anyone who has dealt with an out-of-network insurance/emergency surgery. For context, I am 24, still on my mom’s insurance, Amerihealth. My parents live in Pennsylvania, but I moved to Virginia for a job opportunity. It has been hard to find in-network doctors in my area for normal health visits, but this has totally overwhelmed me. Plan Details: I make around $30k/yr before taxes. Deductible – Individual: $250 / Family: $500. Out-of-Pocket Maximum (applies to in-network medical and RX expenses only) – Individual: $8,550 / Family: $17,100. Surgical Services and In-patient Hospital Services – $0 after deductible. Hospital ER: $100 / visit (waived if admitted). I believe the premium is $168.50 The Situation Back in October, I had bad pains in my stomach. I left work early and suffered through the night before going to the only Med Express in my area the next morning when they opened. They believed it had something to do with my appendix and called the closest emergency department and hospital letting them know I was coming. After the hospital ran scans on me and decided I needed an appendectomy, I was under anesthesia in the operating room 30 minutes later. I received an appendectomy and was discharged from the hospital all in one day. Even though this was an emergency surgery and there was no “in-network” hospital within at least 100 miles, Amerihealth is not covering the entirety of the surgery. The cost is over $21,000. Amerihealth says they have an allowed amount of about $7,800 and paid the hospital, but a balance of over $14,000 still remains. It looks like I am going to have to begin an appeal to fight for Amerihealth to cover the insurance. The hospital has already told me that they do not file appeals on behalf of patients. I am very overwhelmed with them only paying for 1/3 of the surgery. I would appreciate any advice on how to handle this situation, successfully write an appeal, or any feedback from someone who has appealed coverage by Amerihealth. Thank you so much for your time and consideration! submitted by /u/Front-Log5205 [link] [comments]Read Morer/HealthInsurance