Insurance Companies Suck!!!

Then there's the ambulance company that wanted $380 to drive me two blocks.

just need to vent, don't expect a productive response on this or really for anyone to read it all:

i had to go to the ER back in july. my cat bit me, the bite got infected, i got antibiotics from my doctor but my hand kept swelling and then i had the pink streaks on my arm. so i went back to the doctor and they said i should go to the ER for IV antibiotics. they ended up admitting me, i spent a couple of nights in the hospital getting IV antibiotics and went home.

we immediately get a letter from our insurance (basically the most expensive PPO plan) saying the claim for care was denied because (essentially) it was not necessary that i go to the ER and so we will need to pay $13,000 for the hospital stay. this is obviously bullshit so we start going back and forth between the hospital and insurance. our hope is that if we can get the hospital to send more info to the insurance company, they'll accept the claim. every time i have to call the hospital billing department i have to call at exactly 8 a.m. because if i call any later than that it's impossible to get through the customer service hold line, which hangs up on you if you hold for longer than 6.5 minutes. they keep saying they're sending info, the insurance keeps saying they haven't got anything. i finally get hold of a manager at the hospital, who says i have to contact a third party who handles their appeals, but the number she gives me for them doesn't work so she says she'll contact their representative and tell me how i can contact them. she has not called me back, and i cannot call her directly, i have to call the aforementioned customer service line and hope to get put through and then ask to get forwarded to this specific manager.

meanwhile my wife's company's benefits manager says we should file an appeal because it's been three months already and we have to submit within 180 days if we want to officially appeal. at least this gives us some sense of agency/control but the appeal also involves including supporting info from the doctor so now i have to try and figure out how to get in touch with this specific doctor and see if he'll help us out with this bullshit.

this has been hanging over my head for months and adding on other stressful life stuff (like parent health issues etc) i feel like i've had some level of stress from this hanging over me every day. i'm so sick of thinking about it.

also can't believe this thread is not used more often lol

Good lord, that sounds like a frustrating nightmare. I hope it all resolves soon, in your favor and with minimal strain.

Very sorry you are dealing with that and hope you get a good decision on the appeal.

ugh, this sucks

this is partly why I've stayed with an HMO (kaiser permanente in my case)... the healthcare provider and insurance company are the same org, so you don't have to deal with this kind of financial infighting (at least I have not)... I guess if I had to ride in a private ambulance, I could be on the hook for that, but fortunately has not happened yet

The HMO is not perfect - they'll inform you of your new primary physician via letter, you get no say in the matter - but this unified delivery of care is definitely a lot simpler and less stressful

Their whole strategy is to wear you down until you give up.