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ks mom

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. :)


Senior Member
Yes, it sounds like you need to file an appeal with the insurance company. Information on how to do that will be in your insurance Plan Document or insurance booklet (look in the very back.)

Ultimately, you are responsible for payment of the bill. If your insurance company doesn't pay it, you will have to. I suggest you contact the ambulance company and tell them what's taking place with the carrier, that you are appealing the decision, why it appears clear the insurance carrier is liable for the bill, and ask for their patience. You don't want them to turn you over to collection while you're waiting for a response from the carrier.


same thing happened to me in 1999

Hey! The same thing happened to me in 1999. A few days after Christmas, I woke up in severe stomach pain. Couldn't stand up, nausea, fever, etc. I called an ambulance since I couldn't drive myself.
I was eventually diagnosed with having an appendix that was about to rupture. Had emergency surgery and was in the hospital for a week.

After all that, I got a bill for the county's ambulance service. Turns out the company had listed my complaint as nausea. Which is not something the county considered a "transportable" condition. They thought I could have driven myself to the hospital. So they billed me for the amount.

I contacted the county and explained the true diagnosis. Everything was resubmitted to the insurance company, and I wound up not having to pay the bill.

So everybody is right. Contact your ambulance carrier, explain the situation. And resubmit to your insurance company!

Good luck to you.

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