Wanting some information! - Health Insurance Issues Message Board

Gemi_Lee · 11-06-2003, 08:24 PM

Hi All
I had a heart attack last month! problem is my insurance blue cross/blue shield are refusing to pay for air transportation! Is their anything I can do to get them to pay for it? Any information would be appreciated.

mlwrn · 11-07-2003, 06:48 AM

Quote:

Originally Posted by Gemi_Lee

Hi All
I had a heart attack last month! problem is my insurance blue cross/blue shield are refusing to pay for air transportation! Is their anything I can do to get them to pay for it? Any information would be appreciated.

Gemi Lee - I have a few questions for you and a place for you to start with your denial. Did they issue a denial letter? If so, what was the reason they denied this?
Also get a copy of your certificate of coverage. This will have listings of what is and isn't covered.
I know the answer to this question might be obvious, but was it medically necessary to be transported in this way or could you have been safely transported by a ambulance?
Also what type of plan do you have?

(I know these questions might seem a little strange but I worked in Grievance and Appeals for an Insurance Company for over three years and these are things that are looked at.)

I hope this helps to start.

Gemi_Lee · 11-07-2003, 05:29 PM

Hi mlwrn Yes they did issue me a denial letter yesterday.
It said our review indicates this is not a covered benefit under my contract because documentation does not show medical necessity for air-ambulance transport,
The reason they air lift me was I had a heart attack I had a artery completely blocked they had to get me to a cardiac hospital where they could put a stent in my heart.........In the ER they gave me some blood clot busters they said their was a chance of me having a stroke before getting me to the other hospital so that was the reason they flew me out.
I am so mad at them..........you know what they charge for that? mine was almost $10,000.

I thought I had a great plan $500. deductable
co-pay-25.00
ER 20%
urgent care $50.
inpatient-20%
outpatient-20%
mental health-$25.00

Do you think I can check with the hospital to see if there report says it was medically neccesary for me to be air-lifted?

Thank you for responding

mlwrn · 11-07-2003, 07:04 PM

Gemmi Lee...Definitely get a complete copy of the medical records from the ER that treated you, the medical records from the air ambulance flight, and then the medical records from where you were transported to. These are all needed to paint a complete picture. Don't get discouraged, this is just the beginning and for the amount of money charged, it is definitely worth the fight.

Gemi_Lee · 11-08-2003, 09:34 AM

Thanks mlwrn for your help!

I'll do that.