I suffered a traumatic injury earlier this year. I presented to a Tier I facility and was told my injury could not be treated at that facility (no covering specialist available). I was transferred from the ER of the Tier I facility to the ER of a Trauma center (Tier II facility) and admitted for multiple days and underwent surgery.
My insurance company is billing my services as done at a Tier II facility (only covering 70% of services, as opposed to 100% for Tier I per my plan) and my surgeon was out of network, in which case they are not negotiating surgical costs, which puts my allowable billed amount greater than my out of pocket maximum.
How likely am I to succeed in appealing to get my bills covered at a Tier I level, and my surgeon costs covered given I initially presented to a Tier I facility and I required transfer because of lack of resources at that facility?
Thank you.
submitted by /u/lectric_toothbrush
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I suffered a traumatic injury earlier this year. I presented to a Tier I facility and was told my injury could not be treated at that facility (no covering specialist available). I was transferred from the ER of the Tier I facility to the ER of a Trauma center (Tier II facility) and admitted for multiple days and underwent surgery. My insurance company is billing my services as done at a Tier II facility (only covering 70% of services, as opposed to 100% for Tier I per my plan) and my surgeon was out of network, in which case they are not negotiating surgical costs, which puts my allowable billed amount greater than my out of pocket maximum. How likely am I to succeed in appealing to get my bills covered at a Tier I level, and my surgeon costs covered given I initially presented to a Tier I facility and I required transfer because of lack of resources at that facility? Thank you.
submitted by /u/lectric_toothbrush [link] [comments]Read Morer/HealthInsurance