Yikes..insurance question.

Yikes..insurance question.

Teresa
Teresa

August 16th, 2012, 4:26 pm #1

Today I received a letter in the mail from EBCBS that they are denying my stay in the hospital because "you are pregnant and being admitted for side and belly pain is not an emergency" REALLY, EBCBS, really?

I am flored. First of all, I asked the Drs the first night we were there, if it was necessary that I be admitted. They told me absolutely yes it was. I had a kidney infection, passed a stone and had to be monitored for preterm labor. As a high risk patient, they would NOT let me leave, until they felt it was safe.

Are we going to be responsible for paying for a 5 day hospital stay and all the tests, ultrasounds of my kidneys and abdomen, IV's etc etc etc...even when the doctors insisted?

My husband is calling them today, but in the meantime, I'm concerned..I can't imagine how much that 5 days in the hospital would even cost but I am sure it's well into the thousands that we would never be able to afford.

Anyone ever get denied and is there anything we can do about this? Should we speak to our OB about this as well, can they do anything?
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Erin
Erin

August 16th, 2012, 4:44 pm #2

I'm getting ready to go to my scan, but I just wanted to quickly say that, having dealt with these issues over the past 20yrs, I can almost guarantee that you won't end up having to pay this. Insurances love to throw up road blocks w/ the hope that they might get to hold on to money they owe you/the medical providers, but you will almost always win if you fight it. I'll write more when I get back but truly, try not to worry about this one- I am nearly sure you will be fine!
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Teresa
Teresa

August 16th, 2012, 4:57 pm #3

Hope you will update later!
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Mrs. A
Mrs. A

August 16th, 2012, 5:27 pm #4

Today I received a letter in the mail from EBCBS that they are denying my stay in the hospital because "you are pregnant and being admitted for side and belly pain is not an emergency" REALLY, EBCBS, really?

I am flored. First of all, I asked the Drs the first night we were there, if it was necessary that I be admitted. They told me absolutely yes it was. I had a kidney infection, passed a stone and had to be monitored for preterm labor. As a high risk patient, they would NOT let me leave, until they felt it was safe.

Are we going to be responsible for paying for a 5 day hospital stay and all the tests, ultrasounds of my kidneys and abdomen, IV's etc etc etc...even when the doctors insisted?

My husband is calling them today, but in the meantime, I'm concerned..I can't imagine how much that 5 days in the hospital would even cost but I am sure it's well into the thousands that we would never be able to afford.

Anyone ever get denied and is there anything we can do about this? Should we speak to our OB about this as well, can they do anything?
I believe that the insurance regs/law in NY stipulate that if you are admitted into a hospital - ANY hospital - via an ER visit that your insurance must provide coverage as it would normally do otherwise. I know that is the case here in NJ but am almost certain it is in NY as well based on a friend's experience with her child's care.

You can and should appeal. Just give a call right now as first line of action and try to get more information. Find out the appeal process and start that. Also, don't hesitate to file a complaint with NY State Department of Banking and Insurance (the agency would have a name to that effect) which oversees insurance companies. And keep the hospital in the loop (document it the conversation) and don't pay a penny until you have final resolution on the matter.
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Gym girl
Gym girl

August 16th, 2012, 5:46 pm #5

Today I received a letter in the mail from EBCBS that they are denying my stay in the hospital because "you are pregnant and being admitted for side and belly pain is not an emergency" REALLY, EBCBS, really?

I am flored. First of all, I asked the Drs the first night we were there, if it was necessary that I be admitted. They told me absolutely yes it was. I had a kidney infection, passed a stone and had to be monitored for preterm labor. As a high risk patient, they would NOT let me leave, until they felt it was safe.

Are we going to be responsible for paying for a 5 day hospital stay and all the tests, ultrasounds of my kidneys and abdomen, IV's etc etc etc...even when the doctors insisted?

My husband is calling them today, but in the meantime, I'm concerned..I can't imagine how much that 5 days in the hospital would even cost but I am sure it's well into the thousands that we would never be able to afford.

Anyone ever get denied and is there anything we can do about this? Should we speak to our OB about this as well, can they do anything?
I completely agree with the previous posters. The first thing I would do is call your doctor or whoever submitted the claim to find out what exactly they submitted. How does the insurance know it was for "side pains and belly pains"?

Good luck and I'm sure you don't have to worry about this...
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Teresa
Teresa

August 16th, 2012, 6:03 pm #6

I believe that the insurance regs/law in NY stipulate that if you are admitted into a hospital - ANY hospital - via an ER visit that your insurance must provide coverage as it would normally do otherwise. I know that is the case here in NJ but am almost certain it is in NY as well based on a friend's experience with her child's care.

You can and should appeal. Just give a call right now as first line of action and try to get more information. Find out the appeal process and start that. Also, don't hesitate to file a complaint with NY State Department of Banking and Insurance (the agency would have a name to that effect) which oversees insurance companies. And keep the hospital in the loop (document it the conversation) and don't pay a penny until you have final resolution on the matter.
Great suggestions. I will look into all you suggested. DH put a call in already but someone has to "call him back"

Never thought in a million years this would be an issue, our insurance has always been excellent. They wouldn't have admitted me if it wasn't serious. In fact, the ER drs called my OB at 2 am to ask him about me being discharged (before I knew what was wrong with me I really wanted to just go home) and he said I had to stay, that going home was out of the question. I hope that will mean something?

Thanks again, especially for the tip to file a complaint, I would never have known to do that.
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Joined: January 23rd, 2009, 5:02 pm

August 16th, 2012, 6:11 pm #7

Today I received a letter in the mail from EBCBS that they are denying my stay in the hospital because "you are pregnant and being admitted for side and belly pain is not an emergency" REALLY, EBCBS, really?

I am flored. First of all, I asked the Drs the first night we were there, if it was necessary that I be admitted. They told me absolutely yes it was. I had a kidney infection, passed a stone and had to be monitored for preterm labor. As a high risk patient, they would NOT let me leave, until they felt it was safe.

Are we going to be responsible for paying for a 5 day hospital stay and all the tests, ultrasounds of my kidneys and abdomen, IV's etc etc etc...even when the doctors insisted?

My husband is calling them today, but in the meantime, I'm concerned..I can't imagine how much that 5 days in the hospital would even cost but I am sure it's well into the thousands that we would never be able to afford.

Anyone ever get denied and is there anything we can do about this? Should we speak to our OB about this as well, can they do anything?
My guess is, your hospital just needs to code it differently. Talk with your hospitals insurance rep and explain the letter you got and they should be able to handle it from there. I'm sure it'll get covered. Super annoying though!



TTC: Since Nov. 2006
Diagnosis: Ovarian Dysfunction & PCOS
28 Years Old
cd3 FSH 16.8
cd10 FSH 13.6
7 Unmonitored Cycles of Clomid
3 Unmonitored Cycles of Letrozole
Positive CCCT
TAB for cysts
1st Cycle of 150iu of Menopur with Timed BDing - 5 mature follies - BFN
TAB for cysts
2nd Cycle of 150iu of Menopur with Timed Intercourse - 4 mature follies in play - BFN
3rd Cycle of 150 iu of Menopur with Timed Intercourse - 2 follies - BFN
1st Cycle of Gonal F - 1 follie & cyst on right - BFN
TAB for a cycle
2nd Cycle of Gonal F = BFP!!!!!
11dpo Beta=27.9
14dpo Beta=120
16dpo Beta=210
18dpo Beta=429
21dpo Beta=1064
5w6d - baby measuring 3mm, h/b 101
6w6d - baby measuring 6mm, h/b 126
7w6d - baby 18mm, h/b 171, measuring ahead at 8w2d! RE noticed enlarged yolk sac so keeping a close eye on that
8w6d - baby 2.52cm with h/b of 174
9w5d - baby 3.22cm with h/b of 180 measuring 10w1d
10w6d - baby 4.34cmcm with h/b of 174 measuring 11w1d
12w u/s showed baby at 11.2cm with h/b of 162 - unfortunately, that evening I suffered a horrible m/c of a chromosomally NORMAL girl.... RIP my angel girl...you were loved....

Gonal F with Timed Intercourse-2WW
First cycle of Gonal F with Timed Intercourse since m/c - BFN
2nd Cycle of Gonal F with Timed Intercourse - BFN
TAB for a month on bcp's
3rd Cycle of Gonal F - BFP
-11dpo beta=14.9
-14dpo beta=45.7
-16dpo beta=140
-18dpo beta=366
u/s at 6w1d showed heart-rate of 114!!!!
u/s at 7w1d showed heart-rate of 141!!!!
u/s at 8w showed heart-rate of 179
u/s at 9w showed 2 SCH's, h/r of 197
u/s at 10w showed h/r of 175
u/s at 11w showed h/r of 180
u/s at 12 w showed h/r of 188
12w2d...m/c'd baby at home, lost too much blood, had to have emergency D&C...severely anemic....baby was a chromosomally normal boy
-developed a blood clot in leg 1 1/2 wks post D&C...saw a hematologist and had testing done and everything came back normal, will still treat me with Lovenex on next pregnancy

-First cycle since m/c....Gonal F, triggered with 8 mature follies, T/I - BFP!
-13dpo beta 106, progesterone 21.4
-15dpo beta 260, progesterone 12.2
-16dpo beta 411, progesterone 16
-20dpo beta 845, progesterone 19 (went in for u/s to rule out ectopic, couldn't see anything yet, but lining was thick)
-22dpo beta 1158, progesterone 18
-24dpo beta 1655, progesterone 20
-5w?? u/s showed 2 sacs...one measuring 4w0d, the other measuring 5w1d....possibly vanishing twin???
-6w u/s showed TWINS! 2 h/r's....121, 119. both measuring 6w1d! SCH 1cm
-At 7w pg, tested positive for lupus anticoagulant, on lovenox to treat it, TSH was 2.55
-7w2d u/s showed 2 babies measuring 7w4d & 7w3d, h/r's 158 & 153! SCH 2cm
-8w1d u/s showed 2 babies measuring 8w3d & 8w2d, h/r's 185 & 179! SCH 3cm
-10w2d u/s showed we lost baby A measuring 9w1d and had no h/r...baby B measured 10w1d with a h/r of 180...praying for Baby B to hang on, SCH gone, started thyroid med
-11w1d u/s showed Baby B measuring right on track, h/r of 174
-12w1d had a red bleeding episode & u/s showed Baby B measuring 1 day ahead and a h/r of 168, bleeding likely caused by Baby A's passing
-13w1d had some red spotting & u/s showed Baby B measuring 2 days behind and h/r of 157
-14w...baby measured 14w3d...and I suffered a horrible, very sudden miscarriage...another angel baby...that makes 4.
Saw Dr Mary Stephenson at U of Chicago for recurrent pregnancy loss....dx with Lupus Anticoagluant and Incompetent Cervix, will be treated with lovenox
5-25-11 - Had a Transabdominal Cerclage placed by Dr Haney at U of Chicago

Gonal F with Timed Intercourse (self medicated/unmonitored) BFN
Gonal F with Timed Intercourse: 7 follies in play - BFP at 10dpo!!!
12dpo hcg level 80.5, progesterone 16.8
14dpo hcg level 295, progesterone 18
6w3d u/s showed 1 baby with a h/r of 120, measuring 6w4d
7w3d u/s showed baby with h/r of 160, measuring 7w3d
7w5d u/s showed a possibility of TWINS! Baby A (the original) measured 8w, h/r 167...Baby B, hiding in the upper uterus measured 6w6d, h/r 176...time will tell if Baby B will make it
8w4d u/s showed Baby A doing well measuring 8w4d and h/r of 185....Baby B measured 7w3d and no h/r detected My 5 angels better help me out through the rest of all this
9w5d u/s showed Baby A measring 9w5d, h/r 188
10w5d u/s showed Baby A measuring good, h/r 175
11w3d u/s shoed Baby A measuring 11w4d, h/r 169
12w6d u/s showed Baby A measuring 13w2d, h/r of 167
13w5d u/s showed Baby A measuring 13w6d, h/r of 156
15w5d u/s showed Baby Girl measuring about a week ahead! h/r 164
17w4d u/s showed Baby Girl with a h/r of 156, cervix measuring 5cm+
19w4d, u/s showed Baby Girl with a h/r of 151, cervix measuring 5cm
23w4d, u/s showed Baby Girl with h/r of 149, cervix measuring 5cm. Baby weighed 1lb 14oz and is in the 80th percentile...her belly in the 97th....talked a little big about GD
27w4d, u/s showed Baby Girl with h/r of 151, cervix measuring 5cm...baby weighed 3lb 4oz, 87th percentile, pass GD test!
29w4d u/s showed Baby Girl with h/r of 148, cervix 5cm
31w4d u/s showed Baby Girl with h/r of 129, cervix 5cm and weight is 5lb 5oz! BIG GIRL!!!
35+ weeks and counting!
Started contracting at 36w, had c-section at 36w2d, Welcome to the world Baby Lorelei, 6lb 11oz and perfectly healthy!!!!
TTC: Since Nov. 2006
Diagnosis: Ovarian Dysfunction & PCOS
26 Years Old
cd3 FSH 16.8
cd10 FSH 13.6
7 Unmonitored Cycles of Clomid
3 Unmonitored Cycles of Letrozole
Positive CCCT
TAB for cysts
1st Cycle of 150iu of Menopur with Timed BDing - 5 mature follies - BFN
TAB for cysts
2nd Cycle of 150iu of Menopur with Timed Intercourse - 4 mature follies in play - BFN
3rd Cycle of 150 iu of Menopur with Timed Intercourse - 2 follies - BFN
1st Cycle of Gonal F - 1 follie & cyst on right - BFN
TAB for a cycle
2nd Cycle of Gonal F = BFP!!!!!
11dpo Beta=27.9
14dpo Beta=120
16dpo Beta=210
18dpo Beta=429
21dpo Beta=1064
5w6d - baby measuring 3mm, h/b 101
6w6d - baby measuring 6mm, h/b 126
7w6d - baby 18mm, h/b 171, measuring ahead at 8w2d! RE noticed enlarged yolk sac so keeping a close eye on that
8w6d - baby 2.52cm with h/b of 174
9w5d - baby 3.22cm with h/b of 180 measuring 10w1d
10w6d - baby 4.34cmcm with h/b of 174 measuring 11w1d
12w u/s showed baby at 11.2cm with h/b of 162 - unfortunately, that evening I suffered a horrible m/c of a chromosomally NORMAL girl.... RIP my angel girl...you were loved....

First cycle of Gonal F with Timed Intercourse since m/c - BFN
2nd Cycle of Gonal F with Timed Intercourse - BFN
TAB for a month on bcp's
3rd Cycle of Gonal F - BFP
-11dpo beta=14.9
-14dpo beta=45.7
-16dpo beta=140
-18dpo beta=366
u/s at 6w1d showed heart-rate of 114!!!!
u/s at 7w1d showed heart-rate of 141!!!!
u/s at 8w showed heart-rate of 179
u/s at 9w showed 2 SCH's, h/r of 197
u/s at 10w showed h/r of 175
u/s at 11w showed h/r of 180
u/s at 12 w showed h/r of 188
12w2d...m/c'd baby at home, lost too much blood, had to have emergency D&C...severely anemic....baby was a chromosomally normal boy
-developed a blood clot in leg 1 1/2 wks post D&C...saw a hematologist and had testing done and everything came back normal, will still treat me with Lovenex on next pregnancy
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Laura
Laura

August 16th, 2012, 7:27 pm #8

Whoever entered the code probably entered your "chief complaint" instead of your "diagnosis" codes. A letter from the insurance does not mean you will have to pay. What happens is they send the denial to the hospital, which then will check again with the company for you because it's easier to get money from them than you. the insurance will tell them "belly pain" isn't enough to admit someone, and the hospital will say "she was admitted for a kidney stone," and then the hospital will code it differently. This happens a lot according to my OB's receptionist. Don't ever worry until you actually get a bill from the hospital. Insurance companies don't issue bills. I've received lots of "denial" letters over the years and never actually ended up getting bills from the hospital or Dr's office.
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Teresa
Teresa

August 16th, 2012, 7:36 pm #9

hubby called ebcbs.

they said the hospital submitted for just one night (not even the whole lenght of stay, not sure why?) and ebcbs said the hospital would have to pick up the tab because they told me to stay. does that sound right to you? something tells me it won't be so simple as this but hopefully im wrong. seems not right....

he had to hang up pretty quick with me as he was heaaded into a meeting, so he will give me the low-down later..but the insurance co told him not to worry, we will not have to pay. i guess my question is...will the hospital? not too good with insurance stuff...

so, didnt appeal yet..will have to wair for more info...

will keep you posted
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BroodyHen
BroodyHen

August 16th, 2012, 9:10 pm #10

glad to hear that your insurer has assured you that you won't have to pay. but boy, the whole thing sure is ridiculous! sorry you are having to deal with this. i say put it out of your mind and go back to resting

how are you feeling?
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