So I got bill from the ambulance service for dd birth. Actually two separate bills...one for me, with insurance (900$) and one for her that the insurance denied ($1200). They said because my pregnancy and delivery was normal I didn't need an ambulance so that is why they aren't covering it. It makes me sick! Should I file something against the insurance company? I'm really hot over it!
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Since when is delivering on the side of the road normal?!
I'd definitely appeal it. My mom (a doctor) said once that 90% of denied claims are approved on appeal.
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what the WHAT? The fact that you ACTUALLY delivered on the side of the road proves that the ambulance was entirely necessary. It's not like you called the ambulance to act as a taxi and delivered 8 hours after arrival at the hospital. Absolutely appeal that bs.
ETA: Not to mention the fact, when the ambulance rolled up your baby was still attached to you (correct?). Did they expect you to waddle on over to your car and pinch the cord until you could get to the hospital? That doesn't seem in any way safe. You were on the side of the road and NEEDED medical attention at that specific location.
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@matador84: Sometimes all you need to get a claim paid is to dispute the non-payment (if that makes sense) by providing the information that most claims folks don't get/have access to (like your medical records). Most of the time, the claims folks are just matching up medical/CPT codes to determine whether or not the claim fits squarely into the coverage bubble.
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@matador84: I would read your insurance policy and see what kind of ambulatory coverage they have.
And then I'd appeal the shit out of it.
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@Mrs. Jump Rope: I agree with you.
I'd appeal the shit out of that. -
What?!? That is insane. Appeal the crap out of it!
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Yes, yes, yes!! Appeal the shit out of it! Insurance companies will deny unless there is a medical reason for transport. And last time I checked, you didn't really want to leave your baby on the side of the road after having her. Supply lots of medical support from your OB and her pediatrician saying that it was 100% necessary. You should have no issue getting it approved.
Also, before you use up an appeal (you should get 3 levels), complain to your benefits department (or DH's benefits department if he holds the insurance). See what they can do first!
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@matador84: I agree with @Mrs. Jump Rope: . Do you know if your insurance covers ambulance rides? Although, yeah, you did give birth on the side of the road. What were you suppose to do deny it and risk bleeding out in your own car?
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Why would it be approved for you and not her? Sounds like they're saying it WAS necessary for you, and she was in the same ambulance! Insurance sucks, definitely appeal.
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@oliviaoblivia: that is definitely encouraging!
@Mae: thank you! I'm so annoyed. That, and the fact they billed me 1200 for her when they did nothing except check her out, cut the cord and given her oxygen. Yep, I was standing up on side of the road with her still attached. What, that isn't normal?!
@Mrs. Jump Rope: ambulatory is 100% in network after I've met my deductible.
@MsLipGloss: I'm definitely going to dispute...I don't really have a problem releasing my medical records--it just seems so ridiculous! -
You gave birth on the side of the road! I'd appeal.
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I never had any luck appealing! Nightmare
In this case it was undeniably necessary so hopefully you'll have some luck. What a hassle!
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@matador84: seems cut and dry to me. I would call and file a dispute. Ask to speak directly to a supervisor if it helps.
The more info you provide, the better chance you have. I would look to see how much of your deductible had been satisfied as of the day you delivered.
So then you can say something like, "as of april 1,2014 we had satisfied $900 of our $1000 family deductible. Our policy states that ambulatory services are covered in full once our deductible has been satisfied.
On April 1, 2014 I have birth to my daughter on x street. We called an ambulance for x reason, who arrived at x time.
The ambulance then transported my daughter and I to x hospital.
We are aware of the terms and conditions of the policy, and are not responsible for $xx because we have a $100 balance on our deductible."
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@matador84: p.s. I had excellent results every time I appealed a denial. Usually it was some information foul up on the insurance carrier's side . . . !
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You've got to be kidding me! Appeal!!
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Oh my gosh.. did they want you to hop back in your car and drive yourself?! For sure appeal. Good luck!!
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Appeal appeal!
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Another vote for an appeal. It seems so clear, so perhaps with more information they'll make the right decision!
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I'm still laughing at 'not necessary'. Tell them to try delivering, monitoring and caring for a baby on the side of the road!
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@swurlygurl: OMG I'm laughing at that too!
I know a bunch of people have already said appeal the shit out of it, but it bears repeating.
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I like @mrs. jump rope's approach. What a load of garbage. I guess the baby should have found its own transportation to the hospital......... insurance billing.
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Appeal! That is crazy, of course it was necessary!
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No way!!! Appeal. How is that a normal delivery?!
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Not the same situation, but I've appealed twice for Homebirth with good results (two different companies). Appeal! Your situation is certainly far from the norm!
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Just curious - did having your LO change your deductible for the year at all? Usually they have a per person deductible and then bump you up to a family deductible once there's kids involved. That said, LOs are usually covered under their parents coverage for the first 30 days, so I'm not sure how that works.
In any case, BE SUPER NICE AND CALM when you call. Get all the angries out before you call. That is the most important thing. Usually if you're really nice and get the rep to essentially sympathize with your situation, they're going to be more apt to help you and eventual transfers to supervisors will be easier because you wont get the "this crazy lady wants to talk to a supervisor" warning.
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I wouldn't appeal, immediately. If you are with UHC, they have "resolution specialists" - I'm sure all companies have something like this. I would call them, explain the situation (roadside birth) and ask them for guidance. Should the claim have been coded differently? Did someone not fully understand the situation? Did someone miss something?
We recently had a claim that was just plain processed incorrectly. Everything was coded and submitted correctly, the processor just made an error. One pleasant 5 minute call and it was all handled.
So I suggest starting with a phone call to better understand if an appeal is needed and how to have the best chance at the appeal.
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I certainly agree with the masses that you should appeal, but I couldn't help but giggle at the idea of you trying to buckle your naked newborn into an appropriate carseat while still attached to you to drive safely to the hospital
. I am sure the ambulance ride was far cheaper than had you been in an accident trying to drive there after you gave birth!
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oh geez, yes please appeal! that's crazy that they want you to pay for that!
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Appeal! I had luck with an appeal from part of my son's birth. Plus, they are charging for your LO, but shouldn't they be covered under your for the first 30 days? Or are not all insurances like that?
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Appeal! That is ridiculous!!
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I would fight it & follow the PPs advice. SO MANY things are negotiable that you don't initially realize are! You just have to not give in. With all of DS2's medical bills I've learned to fight, I always ask the rep's name, use it in the conversation, ask for their direct line to call back, etc.
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Update! I talked to my insurance company again today and they finally got through to the ambulance company and they filed the dx on dd as a normal delivery..,when she was the one being born. At least this is what I'm told. She said they are re-filing with the ambulance company and I should have an answer in the next week. They are putting the account on hold and she told me do not pay the bill yet. I'll keep updating as it progresses.
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@matador84: Yay, sounds promising!
. I am sure the ambulance ride was far cheaper than had you been in an accident trying to drive there after you gave birth!
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33 comments