Health insurance Appeal.

[eversoul]

What is the name of your state (only U.S. law)? Nevada

Keeping this Short, I got into a Car accident woke up in the hospital i have United Healthcare as my insurance and the plan i have is for "in network" only

So when i got into my Accident they Rejected my Claim for the Ambulance because it wasnt in network, and this is the ONLY Ambulance company in the entire area.... Also They Rejected my Claim for the Radiological XRays, that was done in the hospital since the Doctor and the Radiological Company wasnt in network.

I went on united healthcare page and Did there provider Search they have NO Ambulances and NO Radiological Services Anywhere in this entire area, closest is a 8 hour drive away (just for Radiological) The plan i have Says that Ambulance Services are covered along will all hospital care providing its "in network" When i got into the Accident i had no choice of which hospital i went too i had no choice which doctor i had i had no choice of anything, so i want to know do i have any options to get these claims accepted?

I am just blown away that the only ambulance company is not in network. Is that even right? And what about The Radiological Service? this is the only company and it does all the X Ray/ CT Scan Services for all the hospitals here.

Any advice will be appreciated. Thanks

[cbg]

I used to work for United Health Care and believe me, it is not their idea that there be no ambulance services or radiology in network, especially if there is only one in the area. They would be more than happy to sign them up. But they can't force the services to sign a contract with them. If the ambulance service, the radiology consult, or anyone else, thinks they can make more money being out of network, then there's nothing United Health Care or anyone else can do to force them into the network.

[ecmst12]

What does your plan say about emergency services?

[eversoul]

i am comepletely covered for all emergency services including ambulance and the like " As long as it is "In Network"". i just think its wrong that my provider form says i am covered by ambulance transport in network but they dont tell you that there are "No" ambulances you can choose from.

[ecmst12]

Typically emergency services are covered regardless of network status....cause it's an EMERGENCY and you frequently don't have a choice, you should go to the nearest emergency room when you are having a medical emergency.

[eversoul]

Yeah that is what i am trying to Argue i was driving home and woke up in the hospital, i had no choice which hospital i went too i had no choice which doctor helped me i had nothing.

Is there any way this can possibly help me asking for an appeal on there decision?

[ecmst12]

It really depends on how the policy is written.

[cbg]

Is UHC refusing to pay any part of the bill at all? Or are they paying a portion but refusing to pay it in full?

It makes a difference what I recommend.

[eversoul]

They are Refusing to pay all of it.