[pinched]

We recently had to make a visit to Emergency Room to treat a cut on husbands face when he fell against fireplace. First, they never checked our insurance until AFTER all procedures done, even though not a life threatening condition.

They did a CT scan, even though treating physician checked bones manually, thought nothing was broken, he showed no signs of head trauma. And then sent us a bill for $2800 that insurance will not cover. Our deductible is $5000.

How can I get some info on the usual cost and reason for a CT scan? What symptoms were there that such an expensive procedure was ordered? My insurance company does not have an ombudsman, or ANYONE that is looking out for their customers. They told us we were on our own or could "hire a lawyer."

Don't know where to turn, have tried state insurance commissioner, who sent me to consumer affairs who sent me back to state insurance commissioner (you get the picture!)

Thanks:mad:

[LearningAsIGo]

Its an awful situation, but its true that the consumer is responsible for determining what is covered by their insurance.. . even in an emergency situation.

CT scans are commonly ordered in an emergency situation - physical exams are not 100% reliable in such circumstances.

Your bill should have a J-code (diagnosis code) on it. If not, call the hospital billing department to ask what your husbands J-code is. Once you have that, compare it to your insurance coverage packet and that should tell you if it should be covered or not. If so, you'll have to keep calling... possibly hire a lawyer to defend you. Remember, insurance companies like to deny coverage and they're willing to put up a fight.

If its not covered under your policy, there is really nothing you can do to contend it.

Good luck!

[pinched]

Can anyone on the list tell me where to go to contest WHY a CT scan was done? In my opinion it was totally unnecessary. Who can I get to look over the charts/med notes besides a lawyer!

The hospital billing dept. says no one has ever asked why a procedure was done, they don't know (not kidding) who to talk to. They suggested our primary care phsyician who said he couldn't help, we went to the wrong hospital. Billing dept gave me the hospitalist. Can't get a return call, she only has a pager and billing office didn't even know where her office was.

The insurance company says since it was out of network, they have no one that will review the charges/records. Our insurance deductible is $5,000 anyway, $10,000 out of network. Either way, we pay 100%.

Oh and because we have insurance, struggled to pay that monthly health insurance payment for over 20 years, we get LESS of a discount, even though our insurance will not pay one penny, than if we DIDN'T have insurance. Why are we paying for insurance then, we get punished!

I just want a medical professional to look at what occurred and say, "yes," there were symptoms that indicated he needed a CT scan. 'Cause I don't see any. Or "no" he thought you had money and insurance.

Thanks, thanks to any one with a suggestion where to turn!

[Cinnabar]

In all honesty you don't have a chance at contesting this. Your husband had a head lac and head trauma(he hit his head on a fireplace!). The doctor wanted to rule out any skull fracture.

It may seem like the hospital is out to get you but the doctor apparently did have your husband's best interest in mind, not to mention that had he not ordered a CT and your husband died of a brain hemorrhage, you'd be a millionaire thanks to his/her malpractice insurance.



If you are unhappy with your insurance then you may want to consider switching providers.