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Author Topic: Fing insurance company  (Read 1279 times)

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Offline PeteNYNJ

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  • When life gives you AIDS...make LemonAIDS!
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Fing insurance company
« on: October 05, 2009, 12:49:00 AM »
I don't know if this belongs here if it doesn't I am sure one of our fabu moderators will move it.

Basically, I get notification that a hospitalization I received in Feb is not covered so I am on the hook for 28K bucks!  Supposedly the hospitalization was "medically unnecessary".  The procedure was an inpatient detox which I went to on the advice of my doctor and the rehab facility I was working with.  I was evaluated by the doctors in the ER and due to my withdrawal symptoms I was admitted for 5 days.  I was also considered a danger to myself so I was involuntarily held. 

How can my insurance company claim this was medically unnecessary.  The hospital was in network and I was held there on a psych hold. 

Needless to say I am doing much better now but this is REALLY stressing me out (being unemployed and all). 

Has anyone dealt with a situation like this?  Any advice? 

Pete

Offline skeebo1969

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Re: Fing insurance company
« Reply #1 on: October 05, 2009, 01:15:31 AM »

  You know Pete I don't know what state you live in.  My spidey sense tells me NY/NJ area....

  Here in Florida when I was Baker Acted by the psychologist at my ASO.  The ambulance ride and stay in the psych ward was covered by the state even though I had no type of insurance coverage.  Reason being is I was involuntarily held.  I did get an ambulance bill, but had my ASO contact the EMS service and explain the situation.

  Now when the police picked me up he said i could go willingly, but as a side note he explained I would be billed for the entire process.  He told me if I was not willing to go, that I would be forced to go, and the ambulance fees/trip would be handled by the state.  He only told me this info to calm me down because I was going ape shit over another possible hospital bill, and it turned out he was not lying.

  Did your ASO have you committed.  If so they have to have an extensive record of doing so for any legal problems that may arise down the road.

  I don't know if the same applies in your state, but that's the way it was in Florida back in 2005.
« Last Edit: October 05, 2009, 01:17:06 AM by skeebo1969 »
I despise the song Love is in the Air, you should too.

Offline GSOgymrat

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Re: Fing insurance company
« Reply #2 on: October 05, 2009, 01:18:39 AM »
The facility that admitted you should have done an insurance precertification to make sure treatment was approved by your insurance company. Check with the hospital and make sure they did everything they were supposed to do. It is easier to get approved for suicidality than alcohol detox. The hospital needs to make the psychiatric symptoms and your involuntary commit the primary reason for admission and the detox secondary. The hospital has a vested interest in getting reimbursed and they know they are more likely to get money from the insurance company than you. You should inquire about an insurance appeal and definitely try to fight this. Many insurance companies will look for ANY loophole to deny reimbursement.

It really sucks you have to deal with this B.S. with all the other things you are dealing with.

Offline skeebo1969

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  • Posts: 5,699
Re: Fing insurance company
« Reply #3 on: October 05, 2009, 01:28:41 AM »
The facility that admitted you should have done an insurance precertification to make sure treatment was approved by your insurance company. Check with the hospital and make sure they did everything they were supposed to do. It is easier to get approved for suicidality than alcohol detox. The hospital needs to make the psychiatric symptoms and your involuntary commit the primary reason for admission and the detox secondary. The hospital has a vested interest in getting reimbursed and they know they are more likely to get money from the insurance company than you. You should inquire about an insurance appeal and definitely try to fight this. Many insurance companies will look for ANY loophole to deny reimbursement.

It really sucks you have to deal with this B.S. with all the other things you are dealing with.

  Yea like GSO said, you should have a legitimate case here to get those fees handled whether by the state, if it was a state run facility that had you involuntary committed, or by your insurance carrier.  That was how it worked out in my case.  Being that you did have insurance, it would be my thinking that the hospital/facility is riding your back in hopes that you do all the legwork to get this rectified.

  I hope you can get it all worked out.  I for one know a bill of this size can cause one to lose their mind.
I despise the song Love is in the Air, you should too.

Offline PeteNYNJ

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Re: Fing insurance company
« Reply #4 on: October 05, 2009, 01:33:43 AM »
Thanks guys for the quick response.

I was told after I was in detox that I was on a psych hold (this happened because I asked to leave because my aunt was dying).  At the time, I was awaiting cobra so I was in the loophole area.  The social workers confirmed that I would be covered and doing the right thing.

What fucking sucks (and I will make tons of noise about) is if you try to get help, you will be denied by BCBS.  Alcohol detox, especial at the point I was at, could be fatal.  They even sent in a cardiologist because my EKG was off the charts!

I am just worried that they will deny me.  What can I do?  I will have to declare bankruptcy! Yeah, read that again all you scumbags who don't think healthcare is a right!!  I will go broke because I tried to help myself with my addiction.  

Sorry, I am just so fing crazed right now.  How much can one person handle?  I mean if God doesn't give you more then one can handle, then he must think I am the Hulk.  

All this shit is even before I have to start with the HIV drugs and treatments.  Next month my 565 dollar a month bill kicks in for my cobra (stimulus ends) so I get to pay that huge premium and not get covered!!  I would be better off being homeless or getting incarcerated.  I just don't know anymore.

Offline Miss Philicia

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Re: Fing insurance company
« Reply #5 on: October 05, 2009, 02:26:07 AM »
Pete, go to the legal dept at GMHC tomorrow
"Iíve slept with enough men to know that Iím not gay"

Offline PeteNYNJ

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  • When life gives you AIDS...make LemonAIDS!
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Re: Fing insurance company
« Reply #6 on: October 05, 2009, 02:29:36 AM »
Miss P

Can I do that as a resident of NJ?  That is my issue  I live in the armpit but have always worked and gotten healthcare in NYC

blahhhhh

 


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