TL;DR: insurance denied huge claim, learned lots about employer managed insurance and got claim paid.
My husband (super fit, healthy, 40) had a stroke at the end of 2016. Insurance denied paying for the medical helicopter used to transport him from a rural medical center with no neurological team to a stroke treatment facility. They said the flight was not “medically necessary.” I appealed twice and was denied both times. All other $225k in claims from his treatment were paid.
Update: we were going back and forth with the medflight company about what we owed. We would get a bill, call and email them and be promised a follow up with the amount we owe. Lucky for us, our medflight case manager was terrible and never followed up, just kept sending us a $25k bill. I finally got fed up after the bill was sent to collections and found a contact email on their website, hoping that someone other than our case manager could help. The President of the company called me the next day, which happened to be a Sunday afternoon. He immediately started researching and pulled it out of collections. He said he runs into this all the time and explained how company insurance plans work. He wrote a letter to my company and I contacted HR. Within a few weeks, I received a phone call that the claim would be paid in full.
Here’s the key things I learned: 1. The employer has 100% discretion over what is paid by the plan. Employers pay insurance companies to manage the day to day, but it is the employer’s ultimate decision. It’s best to assume the employer is unaware that claims are being denied and see if HR Benefits can help you. Don’t let your employer hide behind the insurance company (Blue Cross, Aetna, etc.) if you have a valid reason for a claim to be paid.
My employer partially funds my insurance, but I pay a ton of money each year to have coverage. I have paid to have full coverage and deserve that service.
- Don’t give up. We were almost $25k poorer because I didn’t know what to do.
Submitted April 05, 2018 at 08:37AM by BiffyMcGillicutty1 https://ift.tt/2q7arpm
