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View Full Version : Insurance Company Won't Cover My ER Visit


bskirksx2012
Dec 10, 2012, 05:50 PM
About a month ago, my husband took me to the emergency room because I had painful breathing all day, and woke up that night in so much pain I could barely take a breath. When we got there, the nurse gave me painkillers and told me they would give me a CAT scan to see if it was a kidney or gallstone, and if it wasn't either of these things, they would give me an X ray to see if it was my lung. The doctor then came in and told me that I tested positive on their pregnancy test. He then gave me an ultrasound and told me the ultrasound confirmed it. My husband and I were overjoyed because we have been trying for a year. They didn't do the X ray or the CAT scan because I was "pregnant". My pain subsided thankfully, and I'm not sure what the cause was, although I have a suspicion it might have been a spontaneous lung collapse. I got my period 2 weeks later, and I am definitely not pregnant. Now my insurance company won't cover the hospital visit, because I was never diagnosed. My husband and I cannot pay the entire sum, we feel lied to by the doctor, dissapointed, and now screwed! Is there anything we can do, legally or otherwise? We absolutely cannot pay this bill, and are afraid bankruptcy is our only option.

smoothy
Dec 10, 2012, 05:58 PM
There is more to this story... because even HMO's cover Emergency room visits.

Fr_Chuck
Dec 10, 2012, 06:00 PM
It is unusual for a blood test at the ER and for a ultrasound both to be wrong. It is possible to have one period and still be pregnant, or to have miscarriage.

They did diagnosis, they said you were pregnant. Is pregnancy covered by the policy ?

Have you appealed with insurance company, written to the insurance commission.

First depending on where you are, the amount of the bill may be over the small claims limit?
If not, they would have the attorney there, so first be sure as to the exact wording of the policy, and you may have to go back to hospital and have them do a code to show what was the results of the tests.

AK lawyer
Dec 11, 2012, 08:55 AM
I agree with Fr_Chuck. It appears that the insurance company is mistaken in denying coverage. If need be get an attorney to push it.