Insurance billing question for the board

[tumorboy]

While on vacation in Hawaii. Daughter no pics. Fainted and had a concussion. She had to ride ambulance and go to ER. Anyway the Hawaii a Department of health is now appealing to our insurance company about the payment of the bill. They need our authorization to appeal it and of course it’s voluntary. Assume the insurance company isn’t paying much or little at all. Doesn’t appear to affect me at all from a financial stand point. Should I just ignore it.

 

[themelrosemauler]

While on vacation in Hawaii. Daughter no pics. Fainted and had a concussion.

.

 

[tumorboy]

.

She was 14. So I doubt it.

 

[Funky Bunch]

Is this just for the ambulance ride? Won't they bill you if the insurance doesn't pay?

 

[tarheelbybirth]

She was 14. So I doubt it.

I teach middle school. I don't doubt anything about that age group.

 

[tumorboy]

Is this just for the ambulance ride? Won't they bill you if the insurance doesn't pay?

Evidently in Hawaii it’s different. Insurance company which is United Healthcare says they paid what they will pay which can’t remember off top of head. And that we owe at most 25 bucks. I assume it’s ambulance ride. ER visit was IV only and had separate billing statement for that and it appears statissfied

 

[bhawk24bob]

My general rule of thumb is that you don't need to respond to anything that's voluntary

 

[tumorboy]

My general rule of thumb is that you don't need to respond to anything that's voluntary

Already responded to my jury duty summons with a no thanks. So I feel u player.

 

[theiacowtipper]

Ground or air ambulance?

 

[theiacowtipper]

If it an air ambulance you probably have issues. They can only be regulated by the federal
Government and surprise billing is a thing.

 

[tumorboy]

Ground or air ambulance?

Ground. They billed around 2200. Not sure once again how much United covered or stiffed them. It was about a 3 mile ride in downtown Maui.

 

[TennNole17]

Just commenting to say I hope your daughter is ok, and that insurance is a scam

 

[franklinman]

Evidently in Hawaii it’s different. Insurance company which is United Healthcare says they paid what they will pay which can’t remember off top of head. And that we owe at most 25 bucks. I assume it’s ambulance ride. ER visit was IV only and had separate billing statement for that and it appears statissfied

For $25 i would just pay it and forget it.

 

[tumorboy]

For $25 i would just pay it and forget it.

The ambulance company is asking my permission to appeal. They want to appeal what United has agreed to pay which appears to be minimal. In order for them to do that according to federal regulations. The ambulance company needs to be able to act as an agent for me in dispute of the bill. It’s really weird that’s all. I’m wondering why we’re even involved in what is a essentially an insurance vs ambulance contractor dispute.

 

[83Hawk]

The ambulance company is asking my permission to appeal. They want to appeal what United has agreed to pay which appears to be minimal. In order for them to do that according to federal regulations. The ambulance company needs to be able to act as an agent for me in dispute of the bill. It’s really weird that’s all. I’m wondering why we’re even involved in what is a essentially an insurance vs ambulance contractor dispute.

This is strange. I don't see any reason why they need your permission to appeal. It just doesn't make sense.

Unless there is a chance you will have to pay more money, I wouldn't do anything further.

 

[Joes Place]

The ambulance company is asking my permission to appeal. They want to appeal what United has agreed to pay which appears to be minimal. In order for them to do that according to federal regulations. The ambulance company needs to be able to act as an agent for me in dispute of the bill. It’s really weird that’s all. I’m wondering why we’re even involved in what is a essentially an insurance vs ambulance contractor dispute.

Your insurer is most likely an "out of network" provider for the care provider(s).
For emergencies, most providers will accept the out of network insurer's repayment at their in-network rate; I suspect that this is all they are trying to do - collect payment for services at the in-network rate UHC will pay.

 

[theiacowtipper]

So here is what I bet happened. Healthcare providers can bill whatever they want but insurers can pay what they choose. My suspicion is that the ambulance billed at an advanced life support rate but the insurer only paid on a basic life support rate. The ambulance agency wants the insurer to pay the higher rate and need to appeal.

The other option is that your daughter was not transported to the closest facility but at 3 miles I don’t think that’s the case. Ground ambulance providers are almost always required to accept assignment. Meaning that they have to accept what the insurance company will pay. There isn’t necessarily a network. Basically on emergency situations ground services are always in network. That is dictated under most state law. I have no idea of Hawaii.

Air ambulances are different in that they can only be regulated at the federal level and there is no federal law that dictates that they accept assignment so they usually don’t. Thats the surprise billing you hear about.

I of course have no idea of the specific law in Hawaii and a quick google search showed nothing.

Good luck.

 

[tumorboy]

So here is what I bet happened. Healthcare providers can bill whatever they want but insurers can pay what they choose. My suspicion is that the ambulance billed at an advanced life support rate but the insurer only paid on a basic life support rate. The ambulance agency wants the insurer to pay the higher rate and need to appeal.

The other option is that your daughter was not transported to the closest facility but at 3 miles I don’t think that’s the case. Ground ambulance providers are almost always required to accept assignment. Meaning that they have to accept what the insurance company will pay. There isn’t necessarily a network. Basically on emergency situations ground services are always in network. That is dictated under most state law. I have no idea of Hawaii.

Air ambulances are different in that they can only be regulated at the federal level and there is no federal law that dictates that they accept assignment so they usually don’t. Thats the surprise billing you hear about.

I of course have no idea of the specific law in Hawaii and a quick google search showed nothing.

Good luck.

Thank you. Makes sense. I’m siding with doing nothing. To this date we have only gotten statement of benefits from United Healthcare. Nothing from the ER or Ambulance Company. What she was transported for was most likely dehydration and possible concussion. So I’m really not seeing our exposure here. They haven’t billed, called, carrier pigeoned etc. The incident was 2 yrs ago.

 

[OutbackBowl2017]

Did you take travel insurance on your trip? If so, the insurance will pay any medical bills that you might incur.

Here is an example….We take an annual trip to the Outer Banks, took the trip insurance due to possible forced hurricane cancellation. Long story short, one of our friends on the trip staying at the house on the policy slipped and fell in the house getting out of the shower…landed on the toilet which broke causing a flood on the second floor to the main floor, he had injuries to his head and body from destroying the toilet. Insurance took care of house damage and hospital bills.

 

[HawkMachine]

She was 14. So I doubt it.

I swear to God she said she was 15.