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!!!

[itsmyturn]

I found this on emedicinehealth.com:

When to Seek Medical Care

Battery ingestion is a medical emergency. Proceed to the nearest hospital emergency department

I would re-appeal. It would not hurt to go to an insurance fraud attorney for a free consultation. This should give you enough information to be able to state the attorney's name and his opinion of the reaction of the insurance company....may be all you need.

[elthia]

http://www.poison.org/prevent/battery.asp

If anyone swallows a battery, this is what you should do:

1) Call the 24-hour National Button Battery Ingestion Hotline at 202-625-3333 IMMEDIATELY. Feel free to call collect. Your physician or emergency room may also call. We are on duty 24-hours a day, 7 days a week.

2) If available, provide the battery identification number (from the package or from a matching battery).

3) An x-ray must be obtained immediately to be sure that the battery has gone through the esophagus into the stomach. Do not wait for symptoms to develop before getting an x-ray. If the battery remains in the esophagus, it must be removed IMMEDIATELY. CAUTION: Batteries lodged in the esophagus can cause severe burns in JUST 2 HOURS!! Battery removal is done with an endoscope; surgery is rarely, if ever, indicated. Do NOT give ipecac.

This should help you.

[lindarn]

I was under the impression that the law changed a couple of years ago. I believe that it says something like, if a reasonable person would feel that it was an emergency, that insurance companies cannot deny the claim and say in THEIR OPINION, it was not an emergency. I could be wrong, but I think that this is the reason that the law changed. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[stinger530]

I would have done exactly as you did. Let me guess the doctor you save in the ER was a hospitalist? I would appeal and use evidence based citations. I took my son to the ER the night before my first anatomy exam because he choked on a raisin, spit up and sounded hoase and I was afraid he had aspirated emesis.

[Nina2bRN]

i'm calling the insurance company again tomorrow and making sure the hospital sent in a new claim...i haven't heard back from anyone (hospital or insurance). does anyone know how long i have until its too late to do anything? i've called the hospital already and the lady agreed with me and sent in another claim but i'm afraid if i wait too long to hear anything, it will be too late. what if she forgot to send it in?!

stinger530 i'm glad your little boy is ok. being a mother is the hardest but most rewarding job on this planet!! we moms go through soo much lol.

[nerdtonurse?, BSN, RN]

All I could think was, "yeah, and if you DIDN'T take the baby to the ER and there was a bad outcome, it would have been 'Parents neglect suffering child, resulting in esophageal perforation and death...'"

Shakespeare didn't get it quite right...He should have said, "First, kill all the lawyers, but the insurance guys should be next...."

[stinger530]

Thanks. My "little" boy is all grown up now. A college man. ANd now my eyes are full of tears remembering the sweet little guy he was. Cherish these rich, terrifying, swiftly moving days of your children's childhoods. Those were great days, but man was I ever tired! I'm holding out for grandchildren now!

[amarilla, RN]

i'm calling the insurance company again tomorrow and making sure the hospital sent in a new claim...i haven't heard back from anyone (hospital or insurance). does anyone know how long i have until its too late to do anything? i've called the hospital already and the lady agreed with me and sent in another claim but i'm afraid if i wait too long to hear anything, it will be too late. what if she forgot to send it in?!

personally, i would send in a request for appeal in writing to the insurance company, certified, asap.

without a formal challenge from the insured, the company may not look to reprocess the claim - even if revised. it's less nefarious than it sounds; it's just a matter of the squeaky wheel getting the grease. paper pushing jobs are a whole lot of never-ending detail work and plenty goes unnoticed and undone.

your eob will explain the process and time frame permitted for challenging the claim; on that note, phone calls usually aren't considered formal challenge. send the letter!

best,

southern

(yes, i was a licensed broker. *chuckles.)

[stinger530]

My daughter got sent to an out of network hospital because there were no beds at the one our HMO covered. I wrote an appeal letter, sent it certifed and my claim was paid. It really can work!

[Batman24]

I'd send a certified letter return receipt for proof ASAP just to be on the safe side of things. And I'd include printouts of some of what was linked here. This is such a big waste of time given the circumstances. I'm sorry you are even having to deal with this crap. This is a no-brainer as a battery might have been involved.

[dnp2004]

i have a few thoughts and a little story:

• the hospital may have coded something wrong from the start. this happens all of the time.
  
• even for an adult, the swallowing of a battery obviously justifies an emergency room visit! always has and hopefully always will. common household batteries can be lead acid, nickel cadmium, mercury oxide, alkaline, lithium ion or silver oxide based. a biochemistry degree is not needed to see that any of these could pose a major problem for a 2 year old!!!
  
• i was thinking about the car-rollover claim denial problem that was written about on this thread. i have the feeling that if the writer did not go to the hospital after the accident. but then developed severely debilitating symptoms, that same insurance company would deny treatment coverage because the proper protocol for accident cases is for the person to be looked at the time of the accident! they would even try to claim that no proof exists that the symptoms are indeed from the roll-over!!!
  
• a don't know where any of you live but many states have the equivalent of an insurance commissioner that you may want to contact to regarding the situation. sometimes, other than shareholders, government is the only entity that insurance companies will respect, since they are afraid of losing their license to sell policies in a given state.
  

hope you both receive justice. i have dealt with many of the cases in the past. just recently i had one case where a pregnant patient (who is an rn) started hemorrhaging at home while her husband was at work. she called the ambulance and within 10 minutes was in the hospital. her child had to be c-sectioned prematurely and suffered from underdeveloped lungs. mommy lost 1.5 liters of blood and baby was hospitalized for 41 days.

the insurance company, who will be nameless, told me that i keep the infant hospitalized for too long and then tried to pay for only 14 of the 41 hospitalization days because that was the "well beyond the normally expected stay" in these cases! next, they questioned and then even tried to behind my back, override my choices for infection control (pneumonia). after that they said i should have released the mother much earlier. the icing on the cake was the denials for the ambulance and emergency room reimbursements. i was on the phone with one of their non-medically trained paper pushers when to my horror, was told that she should have driven to her ob/gyn first before hospital admission was attempted.

now this was mom's first child. she told me that dealing with the insurance company was the worst thing that ever happened to her and that it may her more depressed than the actual medical experience.

her rationale was that from the initial 911 phone call to her release from the hospital, everyone around her were loving and supportive. her husband was very respectful of her and took a few weeks off from work to be with the family. she told me she felt that all of the hospital staff treated her and her baby as if they were their own children. she said she could see slow but significant improvements in her babies respiratory system. this is why she did not become upset about the situation during her visit. she said she "just knew" things were going to get better in the end.

what did make her very upset were these constant insurance company battles. she had paid them premiums for years. she told me that she felt the insurance company secretly wanted her newborn to die because burial/funeral costs would be much cheaper than long term hospitalization. she even worked out some numbers on a spreadsheet as "proof"! the whole insurance issue left her feeling very depressed and victimized because they would seemly torment her with requests for paperwork, hearing dates, arbitration procedures and unreasonable delays. she finally broke down after she felt she could no longer expect to win against a multi-billion dollar insurance company with teams of attorneys.

to make a long story short, because of this drawn out battle, she decided to leave the u.s. and moved to live near her parents in a nice suburb just outside of sydney australia. she is working as an rn in, you guested it, obstetrics! i am happy to report the family is healthy, happy and last but not least, insured!.

now, who said stories don't have happy endings anymore?! :wink2:

[AirforceRN, RN]

Just out of curiousity...what does an ER visit with X-rays go for nowadays?