Ambulance Services treated as Out-of-Network

[sefnfot]

What is the name of your state? Services was in California, but the primary plan is in Maryland.
I have a grandfather PPO plan from Carefirst of Maryland.
I reached my out of pocket limit for the year.
I had 911 ambulance service from Los Angeles Fire Department. I was billed $2,745 by the LAFD.
Insurance only reimbursed me 907.40. saying they are applying out of network limits.
I appealed that decision. My appeal was denied. ( I claimed that out of network pricing does not apply to 911 emergency ambulance services.)
In addition, the insurance carrier did not provide a decision within the required 60 days.
I processed a complaint with the Maryland state Insurance Dept & Attorney General .

what do I do next?
do I file a lawsuit here in California since this is where I live and where the services was done?

 

[cbg]

On what basis are you claiming that OON pricing does not apply? Is that written into your insurance contract? Can you find state law, applicable to your situation, that says so?

 

[adjusterjack]

Insurance only reimbursed me 907.40. saying they are applying out of network limits.

Saying? How did they say it? In writing? With an explanation of your plan limitations?

My appeal was denied.

How was the appeal denied? In writing? With an explanation of your plan limitations?

Those are important questions. If you received anything in writing, please quote it word for word.

 

[sefnfot]

Saying? How did they say it? In writing? With an explanation of your plan limitations?



How was the appeal denied? In writing? With an explanation of your plan limitations?

Those are important questions. If you received anything in writing, please quote it word for word.

both are in writing, I will work on posting word for word

 

[quincy]

both are in writing, I will work on posting word for word

If you do post anything “word for word,” please leave out all personal identifying information. Thanks.