Help! Last week my daughter had all the symptoms of a stroke so an ambulance was called.?

Question

The EMT's agreed she was showing signs of a stroke and rushed her to the nearest emergency room. This hospital is considered out-of-network by her insurance company, Echo, and are only willing to pay out of network coverage (40%). Also, her speech was affected during this time so she had no say so in where she went. Does anyone know the best way to get the insurance to pay this hospital bill as in-network instead of out-of-network. I always thought if it was a true emergency they had to pay no matter what facility you were taken to. thanks!

Answer 1

The best and probably only answer is to file an appeal with the insurance company. I work for an ambulance service and we provide emergency services in several areas and we are not providers for any insurance company. As a matter of fact, BC/BS does not have any providers in our state,so therefore they consider all of our claims out of network. It is up to the insured to file the appeal. They are, after all, the one that has paid the premium and is at a loss if payment is not paid properly. Also, the ambulance is going to take the patient to the nearest facility in the case of a true emergency to get the patient stabilized.

Answer 2

The ambulance can take her to any hospital, but if she needed to be admitted they were supposed to transfer her to a hospital in-network.  The insurance may still be responsible, but the hospital may need to write off the difference for not doing what they're supposed to.

Answer 3

They should pay this as in network. You will need to send a written appeal. Contact your insurance company to see what documentation they require. The hospital and ambulance company will probably need to submit the medical records.

Answer 4

If it's really an emergency, like a stroke, they do.  It's going to be based on her final diagnosis.  If it was NOT an emergency, even though you THOUGHT it was, they don't.