Insurance

I would appreciate any help anyone can give me on this.

I had a miscarriage in July late on a Friday night. I called my doctor’s office who then told me to go to the Emergency Room which I did. I have BCBS health insurance and should only have a $50 copay for the emergency room.

I received my first bill in August or Sept. and nothing was being covered. When I called BCBS, I was told they need the date of onset and that it wasn’t being coded as emergency. I called the hospital and told them that. I thought this was taken care of.

Fast forward to now. This is a $1406 bill. I just hung up with BCBS, and they have now decided not to cover it because a missed abortion (which I guess is a miscarriage) is not an emergency service. It is an outpatient service even though I was treated through the emergency room and went there per my doctors request. They also told me it was pointless to try and get them to review the denial.

Here’s where you guys come in. I am sitting here crying and I don’t know what to do next. Anybody know how to fight this? BCBS won’t give me the CPT code that they need to cover this. I just don’t understand how they can deny the claim when I was told to go to the energency room by my doctor and then it is not an emergency. Any help would be greatly appreciated. Thanks!

Comments

  1. says

    I'm sorry to hear that you had to go through a miscarriage and now you are subjected to this.

    First and foremost, call BCBS back and get detailed instructions on how to file an appeal. I have had to appeal an emergency room visit through BCBS Michigan (they're all independent groups). With my coverage, the first step was to request a medical review, which I was able to do over the telephone. Luckily for me, that cleared up the situation. But, through my earlier conversation, I know that there was also a 2nd, written, formal appeal that could be requested after denial from the medical review.

    Regardless of what they tell you, do not go without appealing this as much as you can. Become the biggest niusance they have ever encountered. Eventually you will find someone who is in their right mind who will swing this the other direction.

    There is no question that a middle of the night miscarriage is something that warrants an ER visit (I worked 3rd shift in an ER for 3 years — I didn't see the billing side or the payment aftermath, but the visit was required as much for psychological health as it was for physical health…)

  2. MichelleD says

    I stopped by here from AmyJo's (Bellclapper Garden)site, and I want to encourage you to appeal this decision. Several years ago, I had a miscarriage that ended up in me taking an ambulance to the emergency room for emergency surgery. The insurance company said I was supposed to have a D&C preapproved and they weren't going to cover it. I appealed, and eventually they covered everything, including the ambulance.

    So, do what the other commenter said…be a nuisance to the insurance company.

    I'm sorry for your loss. It's been years since my experience, but the pain is still real. Hang in there!

    Twinkling for Jesus,

    Michelle

  3. says

    I have no real imput here as I am from Canada and all our medical is covered. I just wanted to chime in and say hang in there and become the biggest pain they ever encountered. I'm routing for you and am so sorry for your loss.

  4. Tricia says

    I'm a nurse- but I'm in Canada. We don't have to deal with HMO's and I'm so happy we don't when I hear stories like yours.

    I'm so sorry that you are going through this.

    Is there any way that you could get something in writing from the doctor that told you to go to the Emergency department?

    Also, you should be able to go to the hospital and get a copy of your records. You might have to pay to have them copied but the information in the records are yours. I'm sure it's the same in the US as in Canada.

    Perhaps you can get the records of your visit and scan through them to try to find anything that proves that your situation was an emergency.

    I know it was- but if there is anything in the records indicating that you had extremely low or high blood pressure, or were bleeding very heavily etc that might be proof for the insurance company that it was necessary for you to have gone through the ER.

    I hope that some of this helps. I do agree that you should learn how to fill out an appeal properly and go for it.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>