Thursday, August 04, 2005

Stay Healthy

The day before Thanksgiving last year my youngest daughter showed us that she is truly following in her klutzy mother's footsteps. She had been playing with her toys in the back room when her sister called her to "come quick" from the front room. Of course she took off running and happened to trip over one of her toys she was playing with, a Little People school bus. When she tripped she hurt herself. She would not stop crying and she would not stand up. When I did get her to stand, she would only do so with me holding the brunt of her weight and she refused to put down her one leg. I feared that she had broken it. (You can not reason with a two year old to try and wiggle her toes when she is hysterical.) I knew that she had really hurt herself. The kid may be a klutz, but whenever she gets a boo-boo a kiss and a few minutes of cuddling usually solve it. This time it didn't. Then I looked at her ankle again and it was starting to swell rapidly. I knew I had to take her to the hospital to find out if it was a sprain, a broken bone, or if anything was torn. After many hours and two sets of x-rays (during which she screamed "No, No, No" and "Stop It" at the top of her lungs while being forcefully held in place) she was diagnosed with a severe sprain and was put into a temporary splint to keep her leg immobile. But without that visit to the emergency room and treatment the sprain could have become worse. As it was it took her nearly a month to walk again (some of which stemmed from an intense fear or the pain recurring). But don't you all worry now, she is running around here fine and dandy. Apparently taking your child to the emergency room for an emergency situation constitutes attempted insurance fraud. For months now we have been dealing with my husband's work insurance. Trying to get them to cooperate and pay for the medical bills from the before mentioned visit. It wasn't until March that we even heard that there had been any difficulties with the insurance not paying the hospital and doctors bills. Then we got a bill from the hospital. It seems that the hospital tried to file the claim electronically and it was rejected. You see the insurance company does not accept electronic claims, only paper claims. So we figured that was the end of that. Then we got more notices from the hospital of the unpaid debt. Call again... Oh we just re-submitted the claim, ignore that threatening letter you received. Then a bill came from the doctor. Apparently his bill wasn't paid because he wasn't considered "in network". Huh? We went to the in-network hospital and he was the person on staff who saw my daughter for all of 3 minutes, and somehow he doesn't work there? The funny thing about this is that he was the same doctor who treated my daughter that past summer when she fell out of a shopping cart (did I mention Dare Devil likes to climb?). And there was no dispute then about paying any of the emergency medical bills. So we had to take care of this whole mess about how the doctor bills separately from the hospital (apparently the insurance company doesn't approve of that). Then we had to go through the whole, I don't see any record here of a hospital emergency room admission. Ummm... Yeah, because you all keep refusing to pay for it. Oh, well, once we get that claim then we will be able to recognize the doctor as being in-network. Huh? Once we get the hospital claim then we can accept the doctor claim. So check back with us in three weeks. If the hospital bill hasn't been paid by then, call us back. Ohhh-kaaay. This continued on and on until the end of June. Finally! We had thought that we were through with it. Then in today's mail we get a letter stating that we had to call the insurance company regarding the hospital emergency room visit of our daughter. Hubby is really ticked by now. This happened 10 months ago and still was not resolved? He calls up and the lady on the other end is giving him a hard time about the emergency room visit. Oh yes, we love to torture our children by giving them proper medical care. We are so devious that way. He keeps talking to her and having to explain over and over again how she got hurt. Yes, she tripped over a toy. Yes, she was at home. No we did not claim any homeowner's insurance. Yes, she tripped over her toy and sprained her ankle. She tripped and sprained her ankle. Yes. No, we did not collect any other insurance on this. Hmmm... I wonder why hubby is turning a lovely shade of red. Oh is that steam coming out of your ears darling? Do put on the kettle I'd love some tea. Now the insurance company is sure that we are not trying to scam them. That we haven't somehow sued ourselves for some insurance from our homeowner's policy to cover said medical bills. Only now will they pay everyone the money owed. Or will they? Why do I have this niggling little feeling that we have not heard the end of this? The American Health Care System! Even with insurance you're screwed.


Anonymous Anonymous said...

We went through a similiar scenario with my son & his broken arm. They had to take him from the ER to the OR to set it because they had to put him to sleep to set it. I neglected in the middle of all this to call for preauthorization, and they refused to pay, saying it was "elective surgery". The insurance manual clearly states "broken bones" are a reason for an ER visit without authorization. ARRRRGGGHHH. It took us months and many appeals to get them to pay. THEN, they kept hasseling us about, are you getting any other insurance payment for this (homeowners, or whatever). (we weren't--it was an accident--he fell playing basketball) It turns out they can confiscate that other insurance to get their money back. I hate insurance companies.

8/05/2005 8:39 AM  

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