K
ks mom
Guest
What is the name of your state? AZ
To make a long story short, my son was diagnosed with diabetes in June of 2001 and I have a few questions....here goes: My son had gotten the "flu" but when he started to drastically lose weight and get worse, we took him to an emergency clinic. There, he was diagnosed with diabetes and we were told that because his blood sugar level was so high, he was in what they call diabetic ketoacidosis...the clinic recommended he be admitted to a hospital immediately, so they called an ambulance. (They, of course, would not let us transport him ourselves..) My husband had called the insurance co. right there at the clinic, to make sure of which hospital he should be rushed to.
When admitted to the hospital, our son was in Pediatric Intensive Care for nearly a week. We never received bills from the hospital or anything, so we assumed everything was covered.
Over a year later, on June 29, 2002, we received a bill from the ambulance company, stating that the insurance co had denied the claim. We called the insurance co and they looked into it and told us the reason for denial was because the ambulance co had written "nausea w/vomiting" on the claim form, and that they only cover "emergency transport". Once we explained to them that he was diagnosed with diabetes and was transported from one medical facility to another, insurance co said to have ambulance co change information and resubmit the claim. We did exactly that and ambulance co told us to disregard the bill. Well, two days ago, the ambulance co called us again and told us that the insurance co denied the claim again... same cat and mouse game...I called the insurance co. and they said yes, it was denied because that is "not a covered service" under the insurance.... however, our Member Handbook says it IS indeed a covered service as long as it is an "emergency".
My question is, what are our options?? Can the ambulance co. bill us after going an entire year of not contacting us? Do we need to file an appeal with the insurance co.? If anyone can give me any advice, I would greatly appreciate it.
Thanks so much.
To make a long story short, my son was diagnosed with diabetes in June of 2001 and I have a few questions....here goes: My son had gotten the "flu" but when he started to drastically lose weight and get worse, we took him to an emergency clinic. There, he was diagnosed with diabetes and we were told that because his blood sugar level was so high, he was in what they call diabetic ketoacidosis...the clinic recommended he be admitted to a hospital immediately, so they called an ambulance. (They, of course, would not let us transport him ourselves..) My husband had called the insurance co. right there at the clinic, to make sure of which hospital he should be rushed to.
When admitted to the hospital, our son was in Pediatric Intensive Care for nearly a week. We never received bills from the hospital or anything, so we assumed everything was covered.
Over a year later, on June 29, 2002, we received a bill from the ambulance company, stating that the insurance co had denied the claim. We called the insurance co and they looked into it and told us the reason for denial was because the ambulance co had written "nausea w/vomiting" on the claim form, and that they only cover "emergency transport". Once we explained to them that he was diagnosed with diabetes and was transported from one medical facility to another, insurance co said to have ambulance co change information and resubmit the claim. We did exactly that and ambulance co told us to disregard the bill. Well, two days ago, the ambulance co called us again and told us that the insurance co denied the claim again... same cat and mouse game...I called the insurance co. and they said yes, it was denied because that is "not a covered service" under the insurance.... however, our Member Handbook says it IS indeed a covered service as long as it is an "emergency".
My question is, what are our options?? Can the ambulance co. bill us after going an entire year of not contacting us? Do we need to file an appeal with the insurance co.? If anyone can give me any advice, I would greatly appreciate it.
Thanks so much.