Insurance coverage for ER visit

Published

Or lack there of? My girlfriend and I are both RN's. I work in a hospital and her in a memory care facility. About a month ago she visited an ER due to some severe abdominal pain she had for approximately 4 days straight and after seeing some unexpected lady partsl discharge. A tad bit afraid there was some sort of miscariage. She made sure that this specific hospital was covered by her insurance before she went because there are about 3 hospitals in our area. She was there for about 6 hours, went through an intralady partsl ultrasound, ct scan, and had labs drawn. In the end they found nothing and sent her on her way. Within a couple days the symptoms cleared and she was fine. Today she got slapped with a $10,000 ER bill! Does an ER's lack of finding anything exempt an insurance company from paying anything?

Up Vote Up Vote ×
Specializes in Home Care.

I used to work for a large medical insurance company as a claims adjuster.

Don't panic about your ER bill, wait until you get a statement from your insurance carrier.

Up Vote Up Vote ×

Gotcha. She's taking it in strides. Had it been me i would be blowing up phones. Will keep an eye out for it.

Up Vote Up Vote ×
Specializes in vascular, med surg, home health , rehab,.

I believe that a reasonable laypersons belief that it is an emergency, and that includes abdo pain, means they will cover it. $10, 000 not bad, my abdo pain with no found cause ran $15,000 in 3 hours; spent months getting bills from 5 docs (I saw an NP only) radiologists, pathologists ( I disputed that as they didnt do any pathology and that bill went away). It was an eye opening experience to see just how crazy the cost of healthcare had become. A bag of LR....$50. EKG...$200 and the labs....even having a pulse ox on for 3 hrs $50. So glad I had healthcare insurance, used my own company, but still in the additional bills for this and that it had to be $1000 out of pocket. Opened my eyes big time. I am sure she'll be covered, so don't worry.

Up Vote Up Vote ×
Specializes in ER/ICU/STICU.

I would still call the hospital and verify that they did submit the charges to her insurance carrier. You don't want to think it has been taken care and two months later you are in collections. Best to act now and make sure everything is being submitted to her insurance.

Up Vote Up Vote ×
Specializes in Emergency/Trauma.
I would still call the hospital and verify that they did submit the charges to her insurance carrier. You don't want to think it has been taken care and two months later you are in collections. Best to act now and make sure everything is being submitted to her insurance.

i agree totally. after my twins came home form the nicu, i received a bill for almost 190k :uhoh3:. luckily, they simply forgot to submit it to my insurance.

Up Vote Up Vote ×

When I got home I looked it over. It was just a statement and said at the bottom it was not a bill yet...still pending insurance coverage. Will wait and see on that. Thanks for the input though!

Up Vote Up Vote ×
Specializes in MS, ED.

Depends on the coding used for the visit, also. If coded as non-emergent, insurance may bounce it back.

Hope it works out!

Up Vote Up Vote ×
+ Join the Discussion