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BCBS Insurance Denial

Discussion in 'Parents of Children with Type 1' started by JHorton, Jun 4, 2013.

  1. JHorton

    JHorton New Member

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    Jun 4, 2013
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    HELP - BCBS denied my insurance claim for ambulance service because I refused transport to the nearest hospital after my blood sugar was 14 and the ambulance was called because I was convulsing. The EMT's started an IV, I came too, I was OK, so denied transport. Now since I denied transport BCBS is denying the $300 bill. I appealed the denial and just received notice today they are still denying the coverage because I denied transport and their decision is final. Has anyone else ever had this happen and did you win? They suggested if I was not happy w/ them I file a civil claim or call the Insurance Division for our state.

    Part of me says it would be easier to forget it and pay the $300 but the other part of me says no way. I didn't need to go to the hospital and by not going I saved BCBS money!!!

    Any suggestions would be greatly appreciated,
     
  2. Melissata

    Melissata Approved members

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    Yes, it happened to us years ago with my son. I fought it and won, but don't recall the details. Things like this are the reason our insurance keeps going up! I would fight it if I were you. They expect you to give up and pay, but if you take the next step, they will likely just cave.
     
  3. LoveMyHounds

    LoveMyHounds Approved members

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    BCBS should send you "Thank You" card :D.
     
  4. Beach bum

    Beach bum Approved members

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    Seriously. This is good for everyone to know in the event they are ever in the situation you unfortunately found yourself in.
    Can you have your endo practice write a letter?

    Glad you are OK!
     
  5. CAGrandma

    CAGrandma Approved members

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    Does it matter who called for an ambulance? I'd think it would be fair if you or a partner/parent/etc called and then "changed your mind" to pay for having the ambulance come. But if it was a well-meaning stranger then maybe they should be sending the bill to them? (no, not really)
     
  6. Turtle1605

    Turtle1605 Approved members

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    So, let me get this straight. If you would have actually accepted the ride in the ambulance and spent several hours in the ER, the insurance would happily pay? This kind of thing makes me so mad. I'd come up with other situations that may result in someone no longer needing the ambulance (like a car accident or someone who thought he/she was having a heart attack) and ask a representative what they do in those situations. Can the ambulance service turn it in as emergency treatment rather than an ambulance call?
     
  7. JHorton

    JHorton New Member

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    Jun 4, 2013
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    It was actually my 5 year old little girl that called and said my mommy is shaking I need help. I spilled juice on her bed and I know she will be mad cuz she doesn't like messes, LOL

    I like the idea of seeing if the ambulance can coded it as emergency services.

    I did turn it into the SD Department of Insurance today and both of my agents are still working on it as well. I have not given up but am doubtful at this point that I will get BCBS to change their minds....

    Yes what they wanted me to do was go to ER then they would have paid 100% of my ambulance ride which would have been $500 not $300 and the ER fee since I have met my out of pocket max for the year.... Such idiots, I saved them thousands of dollars and they are denying a $300 claim. I could write the ambulance service a check tomorrow it's just the whole principal of BCBS and their ridiculous denial!
     
  8. Beach bum

    Beach bum Approved members

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    Give your daughter a big high 5!
    Good for her for cool thinking under pressure.

    Sadly, I am not surprised that the insurance company is doing this. Crazy isn't it???
     
  9. Wren

    Wren Approved members

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    Apr 24, 2013
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    Here's the response from my insurance

    I asked my insurance company (Providence), and was told:

    "Per medical documentation, there is an exception made for evaluation of hypoglycemia-insulin reaction in diabetic patients which resolves with intervention by paramedics. We will pay these claims."

    This is good because we are charged $100 for using the ER if we aren't admitted. (That doesn't make sense either -- I've always thought if my kid needed IV support during an illness, and then could go home unless I said I didn't think I could manage it -- I'd lose money, and the insurance would save money if I opted to take her home.)
     

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