Out of network Emergency cost

[familyman]

Last year I went to emergency to out of network emergency for injury . Naa insurance vadiki call chesta idi cover avutundani chepindu .. but after processing claims provider says they don’t have contract and asking me to pay full amount.

 

please suggest what’s the best thing to do now ?

[Sputnik]

You're falsely informed so vadu accountability theskovali, 

speak to your Insurance customer care, vadu kadhu kudardhu ante say that you would like to speak to his superior.

Usually they should help you if that's their mistake

[anna_gattiga_eyyi]

38 minutes ago, familyman said:

Last year I went to emergency to out of network emergency for injury . Naa insurance vadiki call chesta idi cover avutundani chepindu .. but after processing claims provider says they don’t have contract and asking me to pay full amount.

 

please suggest what’s the best thing to do now ?

As per law

All emrgencies shohld consider as insider and charge as insider. R u sure u went as emergency?

[Epic]

I guess you can start off with requesting the coverage booklet from insurance company, thoroughly go through the booklet and check if your claim is covered or not. If covererd, send a letter(with all service details) to the claims dept with the citation in booklet and the call details you had with them. I did that twice so far, both bills were > 10k, most of the time doctors send wrong codes to insurance companies, in that case hosp might have to resubmit the claim with correct info(this could be a scam!)

[mowa]

54 minutes ago, Sputnik said:

You're falsely informed so vadu accountability theskovali, 

speak to your Insurance customer care, vadu kadhu kudardhu ante say that you would like to speak to his superior.

Usually they should help you if that's their mistake

what's the proof.. ante em sestadu TS

[familyman]

21 minutes ago, anna_gattiga_eyyi said:

As per law

All emrgencies shohld consider as insider and charge as insider. R u sure u went as emergency?

Yeah bro I went to emergency. But thing is I talk to insurance customer care when emergency. Ippudu insurance vadu you can appeal but there is no chance we will pay provider antunnadu.

[familyman]

13 minutes ago, Epic said:

I guess you can start off with requesting the coverage booklet from insurance company, thoroughly go through the booklet and check if your claim is covered or not. If covererd, send a letter(with all service details) to the claims dept with the citation in booklet and the call details you had with them. I did that twice so far, both bills were > 10k, most of the time doctors send wrong codes to insurance companies, in that case hosp might have to resubmit the claim with correct info(this could be a scam!)

Bro coverage undi but thing is out of network which means insurance vadiki provider discount ivvatledu and insurance guy is processing as if it is in contract. So provider can charge me full amount charged for emergency. 

[familyman]

1 hour ago, Sputnik said:

You're falsely informed so vadu accountability theskovali, 

speak to your Insurance customer care, vadu kadhu kudardhu ante say that you would like to speak to his superior.

Usually they should help you if that's their mistake

Call lo kada bro na daggara proof ledu. But I am sure they told it is covered. Ippudu claims guy telling “you can appeal but very less chances they will accept your appeal ani “

[familyman]

28 minutes ago, anna_gattiga_eyyi said:

As per law

All emrgencies shohld consider as insider and charge as insider. R u sure u went as emergency?

Yes bro I am sure I went to emergency. Naku leg lo DVT vachindi.

[mirchi_bajji]

strange. emergencies ki general ga cover cheyali even if out of network.

 

[Sputnik]

24 minutes ago, mowa said:

what's the proof.. ante em sestadu TS

aren't they supposed to record all these conversations.

Customer care ki call chesthe first adhe ga chebuthadhi

[Sputnik]

36 minutes ago, familyman said:

Yes bro I am sure I went to emergency. Naku leg lo DVT vachindi.

is this the first time you went to Emergency?

Previous visits unte they consider you high risk group and change your terms of insurance.

Is there a possibility that you missed mails?

[familyman]

3 minutes ago, Sputnik said:

is this the first time you went to Emergency?

Previous visits unte they consider you high risk group and change your terms of insurance.

Is there a possibility that you missed mails?

This is the first time I ever visited emergency and the first time visit to doctor in USA

[mowa]

26 minutes ago, Sputnik said:

aren't they supposed to record all these conversations.

Customer care ki call chesthe first adhe ga chebuthadhi

they record for their training purposes.. if there is a chat tS email ki transcript pampinchukunte definitega help avtundi..

manam oka allegation sestunnappudu proof manadaggara undaliga..

mana car ni inkokadu guddhithe proof nee dash cam lo undi chupinchu annattu undhi.. 

[Sputnik]

1 minute ago, mowa said:

they record for their training purposes.. if there is a chat tS email ki transcript pampinchukunte definitega help avtundi..

manam oka allegation sestunnappudu proof manadaggara undaliga..

mana car ni inkokadu guddhithe proof nee dash cam lo undi chupinchu annattu undhi.. 

atleast US customer care meedha naku nammakam undhi

Never had a bad experience cheppalante.

Out of their way poyi help chesina instances kuda unde