My mother became sick with a fever at the nursing home she has lived at for 2 1/2 years.
They called me about 8:00 p.m. and said she had spiked a fever and was starting to shake. I said call 911.
The EMT's took her to Mayo since it was close.
I got a call from the ER Doc 30 minutes later. He was very concerned and said if I lived in town I probably need to get there. He said he had never seen someone her age with a 107° temp survive.
They did labs, Xrays and could not find a reason for the fever. No infections. Nothing. By the next day her temp was down to 100. She spent 2 nights and was discharged.
I just got a denial letter from United saying they are denying because Mayo is not in network.
Has anyone dealt with this? If she was going for a routine scheduled appt of course she would have gone to a in network provider but this was an emergency.
I'm so stressed. We don't have an extra 15k laying around.
If you can tell us what kind if insurance Mother has, it would help in getting the correct answers on how to help you proceed.
Mom either has Straight Medicare with a supplimental, Medicare with Medicaid, or a Medicare Advantage. In my opinion, if Mom was in the hospital for 2 days, admitting should have informed someone that the insurance would not be paying for her care if they did not except it so it would be private pay. Or she could be transferred to a hospital that excepts it.
Medicare Advantages are hard to work with that is why at 73 I will not have one. I have done well with Medicare and Blue Cross. I am not going to now be on the telelphone arguing with someone over a bill they should pay. You are talking to someone who is reading from a book probably.
Even on Medicare, there are facilities and doctors that don't take it and Medicaid limits you even more. Usually straight Medicare with a suppliment the suppliment usually pays whatever Medicare allows.
You Moms NH should have it on file what Hospitals Mom can be transferred to. This info would then be been given to the EMTs and they would have to take Mom to that Hospital.
We learn by hit and miss. Me, it was Mom being taken to the ER by ambulance. When she was discharged at 11pm, we were told it was going to take another hour to get a transport. We opted to drive her back and nobody said anything. We get back to the home and they will not allow her in without being transported. Back to the hospital, because she was discharged, we were not allowed back in ER but a nurse said she would call for transport. We waited...then the nurse came out and said the NH was allowing us to bring Mom back. We were told that the Supervisor was called and agreeded to let us return her but this was not normal procedure.
So, unfortunately, approval can change apparently.
If yes, you need to contact United Health care.
If no, you need to contact Medicare. Because your supplemental insurance follows Medicares decision and pays if they do.
My dad had a united health care supplemental plan and they always paid if Medicare did. They were awesome to deal with but, my mom has an Advantage plan and is always complaining about what they don't pay.
Medicare contracts out to these advantage plans. They are suppose to cover Medicare part A & B. They do have networks that you you have to stay within. I would call and talk to a supervisor, not someone who answers the phone. If you can't get anywhere, then let the debt go. You are not responsible for Moms debts.
We have been quite pleased with that health insurance company.
Most of the work in an appeal has to be done by the patient and provider, not the insurance company.
United Health care should have already provided her with a written copy of the appeals process including deadlines, so did that out.They get to choose the rules, at least to start.
No insurance company wants to pay claims, no matter what their marketing campaigns may promise.
That may be the reason for the denial; once on Hospice, you need to contact Hospice to discontinue their care before calling 911.
Hospice should have explained that to you.
Or do you mean that she in on Hospice subsequent to that emergency hospitalization.
In any event, I would appeal. Claim ignorance if you need to.
I'm just shocked to get a letter declining her emergency care. I will file an appeal. Thank you everyone that responded.
Medicare Advantages work lots different than straight Medicare and a supplimental. Same with Medicare with Medicaid.
My daughter just had shoulder surgery in June, and I got a statement from the anesthesiologist that the anesthesia part of the claim was denied, due to not being pre-approved. I called up the office and told them they wouldn't have DONE the surgery unless it had been preapproved. Oh, oops, we put down the wrong code, we'll re-submit. Viola, it got paid!
Sometimes I think they're trying to get one over on people, if they send out enough of these "bills" and even 1% pay, they've made money over and above what insurance pays out. Some people panic and pay it before they even question it, especially if it's not an insurmountable cost (a few hundred dollars, say).
I have a great friend whose MIL worked doing medical coding for an insurance company, she told my friend never, ever pay a medical bill from a hospital or a doctor's office (beyond your expected co-pay) on first notice. If they believe you really owe it, they'll send a second notice; then call the office and question why you received the bill.
That said, this is mom's bill to pay, not yours.
Good luck.
You are not responsible for paying any of her medical bills.
The only way that you can be hed responsible for her bills is if you ever signed any paperwork with the nursing home agreeing to it.
Even if you did, only the nursing home could hold you responsible. Not any other institution if you signed an agreement with the nursing home.
They're just trying to shake you down to get paid. You don't owe them anything. It's a shakedown. Just ignore them. If they harass you too much, let them take it to court. It's not worth their time for 15 thousand dollars.
I hope you win the appeal and another $10K for the pain and suffering the aholes are causing you for all this meshugas.
We have Kaiser insurance and can only go to their hospital BUT in the case of an emergency, we can go anywhere for treatment and they WILL pay the bill simply b/c it's an emergency. And for Kaiser to have that caveat in place means ALL insurance companies should have such a caveat in place. Your mother had a life threatening emergency going on with a fever of 107 and was taken to the closest ER which was the right thing to do.
No, this is not your bill to pay but it IS your aggravation to deal with. Best of luck with the appeal process.
Follow the instructions for how to appeal.
Call the hospital and tell them about the denial and ask for support of the appeal.