Does your insurance company really want you to go to the emergency room?

Emergency Medicine

15 Mar 2020 | 1 | by kjh

10210login-checkDoes your insurance company really want you to go to the emergency room?

Recently I took my son to the emergency room during the weekend, on Saturday. On the previous Friday, we went to the doctor because he had serious symptoms such as headache, blurry vision, disorientation, fatigue, etc.  The doctor diagnosed him with an ocular migraine. However, she said she couldn’t be sure it was the complete diagnosis. She ordered tests, referred him to a neurosurgeon and requested a brain scan. She told him that if he had any symptoms at all during the weekend, he should go to the emergency room right away.

Sure enough, my son’s symptoms worsened on Saturday. He was really scared and thought he would pass out. I drove him to the emergency room.  The emergency room was also not sure if he had an ocular migraine when they looked up the notes from the previous doctor. The emergency room physician recommended that we see various specialists.

When I received the explanation of benefits from my insurance company, it showed that they paid $0. The reason? The emergency room visit was unnecessary.  I called the insurance company and they told me that a migraine headache is not an emergency. I explained that neither doctor knew for sure that was the diagnosis but they put that diagnosis on the bill until further testing was done.

My insurance company told me that if I didn’t agree with their decision, I could fill out a form and answer long questions about why I thought the bill should be covered.  I took a long time to complete the form with accurate dates and information. I submitted the form and was told it was received. Several months later and still no response even when I call.  Meanwhile, I had to pay the bill for the emergency room that was hundreds of dollars. I’ve learned my lesson.  I would still take my son to the emergency room but next time I will have the doctor put down a more serious diagnosis. I thought that if I paid extra for a PPO with a major health insurance company, it would help.  But they do everything they can to deny claims.

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JBBarr
JBBarr
1 year ago

The first thing the hospital asks for is insurance or ability to pay when you check in. And yes, if you aren’t practically dying they don’t think you should be there. I’ve been in the emergency room before with kids crying in pain, people who look dreadfully ill.

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