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So the first insurance hurdle stemmed from the fact that my company has a Health Reimbursement Association deductible plan, meaning that there's a huge deductible that you have to apply for through a separate organization (not the insurance company proper). This is not a problem - all paperwork has been submitted. Other than the deductible, the whole hospital stay, ambulance, ER, nurses, etc. were covered 100%, and I expect full reimbursement of the deductible. So far so good.
The trauma surgeon was another story... I was assigned a great surgeon who did a good job (yay!) but he wasn't in my insurance PPO plan (Boo). I'd rather get a good one than a covered one, (both would have been good but I'm not unhappy with the result).
However, I am now responsible for about $1600 of the surgery bill, maybe a little more. I was told by the trauma surgeon's business office that I have a good chance at an appeal, since who I was assigned by the ER was not my choice.
So... the paperwork for the appeal is prepared and Explanations of Benefits for claims that I've received so far have been copied and attached. I'm still waiting on a few more statements before I send the appeal package to the insurance company. I have about a month to send it in, and they've been pretty prompt so far, so I expect all the statements by this week.
Meanwhile, the insurance company sent whatever they initially agreed to reimburse (not enough, hence the appeal), directly to me because the doctor is out of plan. I can't cash the checks to pay the doctor because that would indicate I accepted their terms. So, the doctor will have to wait for reimbursement, unfortunately (they're aware of that).
So the moral of this story is, give your trinkets to the faeries instead of to the insurance company.
The trauma surgeon was another story... I was assigned a great surgeon who did a good job (yay!) but he wasn't in my insurance PPO plan (Boo). I'd rather get a good one than a covered one, (both would have been good but I'm not unhappy with the result).
However, I am now responsible for about $1600 of the surgery bill, maybe a little more. I was told by the trauma surgeon's business office that I have a good chance at an appeal, since who I was assigned by the ER was not my choice.
So... the paperwork for the appeal is prepared and Explanations of Benefits for claims that I've received so far have been copied and attached. I'm still waiting on a few more statements before I send the appeal package to the insurance company. I have about a month to send it in, and they've been pretty prompt so far, so I expect all the statements by this week.
Meanwhile, the insurance company sent whatever they initially agreed to reimburse (not enough, hence the appeal), directly to me because the doctor is out of plan. I can't cash the checks to pay the doctor because that would indicate I accepted their terms. So, the doctor will have to wait for reimbursement, unfortunately (they're aware of that).
So the moral of this story is, give your trinkets to the faeries instead of to the insurance company.
