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CL2012
LIF Toddler
Member since 1/13 374 total posts
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On the hook for ER copay, admitted at different hospital
I have a family member who went emergently by ambulance to the nearest hospital and it was deemed that he would need transfer to a more sophisticated hospital within the same health system for the care that was needed. So he went to the ER at hospital X and was transferred to hospital Y and admitted. The way his insurance works is your ER copay is waived if admitted. However, he received a bill for the ER copay from hospital X because the admission happened at Y. It's the same health system, but they say it doesn't matter.
I've already made 1 call to both the hospital billing office and my insurance company and both said the same thing, that this is the policy when you're admitted somewhere else even within the same hospital system. I want to try and fight this but don't know what angle to take. Has anyone been in a similar situation and have advice?
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Posted 1/25/17 2:42 PM  |
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Jenhos
Maeve
Member since 6/05 3273 total posts
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Re: On the hook for ER copay, admitted at different hospital
Did the first hospital transport him? Or did he leave on his own and go to the next ER?
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| Posted 1/25/17 2:46 PM |
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CL2012
LIF Toddler
Member since 1/13 374 total posts
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Re: On the hook for ER copay, admitted at different hospital
Posted by Jenhos
Did the first hospital transport him? Or did he leave on his own and go to the next ER?
the first hospital transported him
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| Posted 1/25/17 4:23 PM |
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Jenhos
Maeve
Member since 6/05 3273 total posts
Name:
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Re: On the hook for ER copay, admitted at different hospital
Posted by CL2012
Posted by Jenhos
Did the first hospital transport him? Or did he leave on his own and go to the next ER?
the first hospital transported him
I would think you could fight that. My understanding is if you go to and ER and then leave on your own without being treated you are on the hook to pay. He didn't say hey I want to go to X Hospital instead. I would fight this one!
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| Posted 1/25/17 5:11 PM |
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KarenK122
The Journey is the Destination
Member since 5/05 4431 total posts
Name:
Karen
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On the hook for ER copay, admitted at different hospital
You just need to fight it with your insurance. Almost the same happened to my husband and it took about a year but they paid the first hospital. The point that won it for us was that it was an emergency and he could not transport himself.
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| Posted 1/25/17 5:52 PM |
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Mushesgirl
Too blessed to be stressed
Member since 4/09 6691 total posts
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Re: On the hook for ER copay, admitted at different hospital
Posted by KarenK122
You just need to fight it with your insurance. Almost the same happened to my husband and it took about a year but they paid the first hospital. The point that won it for us was that it was an emergency and he could not transport himself.
I agree with this.
Fight and appeal as far as it has to go, to the medical director of the insurance company. No way you should be penalized for needing a higher level of care and being sent elsewhere not of your own accord. let us know what happens. gl
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| Posted 1/25/17 11:48 PM |
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RainyDay
LIF Adult
Member since 6/15 3998 total posts
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On the hook for ER copay, admitted at different hospital
Fight with the insurance.
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| Posted 1/26/17 8:13 AM |
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Re: On the hook for ER copay, admitted at different hospital
You have to fight these things, they'll never just give it to you. It's obnoxious and annoying but most likely if you stay at it long enough, you'll win.
Took me like 3 months and a ton of hours to get something like this dropped. It's ridiculous.
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| Posted 1/26/17 9:11 AM |
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rebeccamol
LIF Adult
Member since 10/13 975 total posts
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On the hook for ER copay, admitted at different hospital
We had a similar situation, Two hospitals ,same health system, The insurance company actually got the one copay waived. I called them to explain the situation and they said they would pick up one of them,
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| Posted 1/27/17 10:53 AM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
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Re: On the hook for ER copay, admitted at different hospital
Just keep challenging it. Eventually they should waive it.
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| Posted 1/27/17 11:35 AM |
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