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A thread NOT about babies! Ha! (Denial of health insurance claim)

post #1 of 6
Thread Starter 
So my insurance denied my toothpick claim. They said it was merely an Urgent situation, not Emergent, and therefore my choice to go to the emergency room was unacceptable.

I can sort of see their point. Especially the poor guy sitting in an office somewhere that reads a file that says "toothpick inserted in leg." I'd probably deem that non-emergent too, unless I knew the severity of it.

I filed an appeal, explaining that the ENTIRE toothpick went in my leg, and that the ER doc wasn't even able to remove it - it's still in there. (It's almost gone and the wound is mostly closed now, but it's still warm to the touch and there's a big lump there, so I think there's still a bit left in there. :Puke) And also that I was 7 months pregnant at the time and extremelly concerned about blood clots and stress on the baby. And also that I couldn't walk to the car - the paramedics had to carry me.

What do you think the chances are that they'll cover it? (It's $1400. ) Like I need to worry about this right now. We should be talking about, well, babies!!!
post #2 of 6
They need to cover it! I mean yeah at first look they're probably like ok a toothpick got stuck in her leg why did she need to go to the ER, but after your appeal explanation they should definitely cover it. Good Luck!
post #3 of 6
DDC crashing....

I think the letter writing is very smart, but, I would follow up with a BBB complaint.
post #4 of 6
chances are they'll cover it on appeal esp if you give a copy of the report that says the entire t-pick was jammed in your thigh and is still there. an urgent care facility likely would not have taken you b/c of your pregnancy anyway; they'd've sent you to the er for liability reasons alone.

My mother went to ER last year for some sort of viral uncontrollable vomiting thing. Ins refused to cover the dr's portion of the bill stating that it was o.k. for her to go to the er for fluids b/c of how sick she was but that it was unneccessary for her to see a dr while she was there. riiiiiight.. how else was she going to get the fluids and rx to control the vomiting? She appealed it and it was immediatley paid.

If they give you any further grief, go to the state ins commissioner. That usually gets stuff like this taken care of.
post #5 of 6
Quote:
it was o.k. for her to go to the er for fluids b/c of how sick she was but that it was unneccessary for her to see a dr while she was there.
What ER lets you leave without seeing a doctor?

Vegasgirl, you go get 'em!
post #6 of 6
I'm not in your DDC, not even pregnant right now, but well, this isn't about babies . They NEED to cover that! Sounds like an emergency to me! I am sure you can get them to turn around with a fierce letter!
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