How can a city fire department be considered out of network for insurance if paramedic services are needed?

Question

The manager of a movie theater called 911 emergency when I became suddenly sick. I was in a movie theater in the city of Colleyville, Texas. The paramedics took me to a hospital. When I received a bill for this service it was over $1,000. After checking into it, I was told the city of Colleyville is out of network for Blue Cross Blue Shield TRS Active Care 2. As a result, I am billed for $850 in addition to the 20% deductible. I have contacted the Colleyville Fire Department billing service and my insurance company with no help other than each blaming the other. Does anyone have suggestions on how to contest this issue?

Answer 1

God I hate insurance companies.  They're always thinking of new ways to s***w their customers out of the coverage they (or their employers) pay for.  This is one of the reasons we really need universal health care, or at the very least stricter regulations.  I hope this works out for you.  Keep fighting.

Answer 2

Ambulance companies do not contract with insurance companies. They will always be considered out of network.  What you need to do is look at your certificate and see if it states that ambulance services are covered in network when due to a medical emergency or a life threatening condition.  Most policies will allow the in network benefit if used for an emergency condition.  This determination is based on the diagnosis that the bill is submitted with.  If the diagnosis appears to be a general health condition (example, vomiting) then the insurance company does not recognize this to be a life threatening condition whereas the claim is processed as out of network. Many times these claims are overturned and reprocessed when an appeal is done. I would suggest writing a letter of appeal stating the reason for the service and try to make the appeal sounds as much as an emergency as possible. The insurance company may request the medical records to see what type of symptoms you had and also look at how the hospital billed for the services. If they deem it to be a medical emergency than it should be reprocessed. I would also contact the ambulance company and ask them to put a hold on your account until the appeal is reviewed. This could take up to 60 days however most companies will work with you. Good luck!

Answer 3

Send a written statement requesting a reconsideration of the charges. State that this was an emergency and that the ambulance called was the company that had jurisdiction in the area where you became ill. Further,state that you did not have control over what ambulance company came or what hospital they took you to since this was an emergency service through 911.