What would you do in my situation? just looking for opinions.

[Nina2bRN]

hello everyone!

about 3 weeks ago my son comes running up to my husband and i screaming and crying that his little sister swallowed a battery...a battery! she runs into the living room (they were playing back in his bedroom) and acts like shes got something in her throat but we couldn't see anything. so what would any concerned parent do? we take her to the emergency room to make sure she's ok. i know that battery acid can be fatal and she's just 2 years old, so we weren't about to wait overnight to see if something would happen (also this was around 8 at night so no doctors office was open where we live). so as we are driving to the hospital we're trying to calm our 5 yr old son down because he thinks the doctors are going to have to cut her open and also making sure our daughter is ok in the meantime. when we finally arrive she gets some x-rays done and the doctor comes in saying all it clear (wow what a relief!!). but recently we received her hospital bill and guess what??!! insurance didn't pay a penny!!!! i called and they told me that the doctor claimed that it wasn't an emergency...do you believe that? ok...did i not just say that battery acid can be fatal? let alone with a two year old! i'm fighting my insurance with this one and i also contacted the hospital and spoke with three different people...luckily the last woman i spoke with said if she were in my situation she would have done the same thing...finally someone on my side! she also does the medical coding and told me she'd send it in again to insurance...bless her heart.

so anyway i was wondering what you guys think and what you would have done in my situation. you know its crazy to think that people murder their children because they don't care and that some get away with it, but i think its beyond crazy that when someone does care about their kid...sometimes it just doesn't matter or pay in their favor in the end.

sorry for the long post, i'm just a little irritated right now.

thanks for listening everyone and have a great day!!!

[amarilla, RN]

From my experience, the decision of the insurance company is based first on the contract of coverage, then specific to the claim details, coding and billing.

As for what I would do, I would submit a written appeal via certified mail ASAP before the delay in waiting for the claim to be resubmitted and processed runs the time out. I'm not sure which doctor you're referring to coded the visit as non-emergent, but I'd also follow up with the insurance company claims department for the status of the resubmit.

Glad to hear the baby is okay and nothing serious resulted from the scare.

Best,

Southern

[Batman24]

Yeah..that's who I'm fighting The auto insurance.

Have you submitted your bills to your health insurance company?! There is no reason why this shouldn't be covered. A rollover accident is serious and of course you'd need emergency care if only to rule out you didn't have any injuries. If there is a lawsuit involved and you win those paying out would then be reimbursed.

[Sonjailana]

First the health insurance denied it. Then it's been such a struggle with the auto insurance (it was a rental car..so I have to go through the rental insurance first). Today I finally talked to my agent. They have about the worst customer service ever!

[Jolie, BSN]

It is my understanding that the standard of most insurance companies for determining whether or not an ER visit constitutes a true "emergency" is what the reasonable lay person would do.

In other words, if the reasonable lay person would seek ER care for the condition, then it should be covered by the policy.

This came to light when a young man experienced chest pain and went to the ER. He was diagnosed with anxiety and the insurance refused to pay. He appealed and won because the average lay person is not able to determine whether chest pain is due to a benign cause or a serious cause.

I would recommend checking the wording of your policy to determine if it applies this standard to determine payment of ER visits and then find supporting information about the likelihood of a lay person seeking ER care for a child who is believed to have swallowed a battery.

Good luck to you.

This is a huge difference between private and publically funded insurance. Medicare and Medicaid recipients often abuse the ER because there is absolutely no financial consequence of doing so.

[morte, LPN, LVN]

First the health insurance denied it. Then it's been such a struggle with the auto insurance (it was a rental car..so I have to go through the rental insurance first). Today I finally talked to my agent. They have about the worst customer service ever!

which rental company? BAD word of mouth advertising would not be in their best interest....lol

[Sonjailana]

Hertz..I would NEVER work with them again.

[morte, LPN, LVN]

Hertz..I would NEVER work with them again.

just think of all the hmm advertising they just DID NT get, lol

[Sonjailana]

Have to admit, it makes me feel a touch better. I will feel a LOT better when this is all done and settled though.

[Nina2bRN]

thank you guys so much for all of your advice!!! i seriously about went crazy when the insurance company told me that the hospital coded it "fear of concern"....duh...but good gosh we're talking about a two year old swallowing a battery!! and we have good insurance too. i understand that medicaid is harder to deal with but we have normal insurance with my husbands employer and i never thought i'd be dealing with this at all. that's another reason i didn't hesitate on taking her because i knew (well thought i knew) that insurance would understand and cover it. anyway...i'm definitely not letting this drop and thanks for all of the support!!!

oh and sonjailana, good luck with your insurance company too. i really hated to hear about your situation also...keep us posted!

[NursingAgainstdaOdds]

YARGH! Insurance companies are so evil! This kind of behavior on their part really should be illegal.

[Atheos]

This is kinda ridiculous. I looked to see if swallowing a battery was an emergency (I knew it was but never actually looked into why or how) and like 5 million legitimate websites appear exclaiming what a true emergency it is.

I hate insurance companies.

[amarilla, RN]

i seriously about went crazy when the insurance company told me that the hospital coded it "fear of concern"....duh...but good gosh we're talking about a two year old swallowing a battery!! and we have good insurance too. i understand that medicaid is harder to deal with but we have normal insurance with my husbands employer and i never thought i'd be dealing with this at all. that's another reason i didn't hesitate on taking her because i knew (well thought i knew) that insurance would understand and cover it.

it sounds more that the event was improperly coded by the service provider (hospital). the insurance company only processes the claims according to coverage eligibility. follow up with the hospital first to get the paper work corrected and resubmitted on a timely basis; this was their error.

best,

southern