Question
My son had a kidney stone and drove himself to the nearest hospital while in horrible pain. He gave them his insurance card and asked only for a pain shot. They put him in a room and some 30 minutes later finally gave him the pain shot. My husband and I arrived prior to the shot and shortly after the employee came in and handed me my son's insurance card. She said nothing about the insurance card to me or to my son. They told him that they couldn't let him leave until he had an MRI, lab tests, etc. Of course we thought that the insurance would pay for it so we did not argue. Several weeks later he receives a notice from his insurance that they will not pay anything towards the $4000.00 bill. Had the hospital told us they did not take his insurance, my husband and I could have easily driven him to the hospital in our city that did accept his insurance for all of the tests that had to be run. I feel that they did this fully knowing that they did not accept that insurance plan and how expect my son to pay for the entire bill. We all know that the insurance would never have paid the entire amount, they would have paid a discounted amount, but they want my son to pay the full price. My son is self employed and his insurance costs him a lot of money, and it paid nothing. Does the hospital have any responsibility to tell the patient when they do not accept their insurance so they can make informed decisions? Does my son have to pay the entire $4000?
Answer
Hi MarAnne!
I think I would call the insurance carrier to find out the exact reason they will not pay. You said they did not take his insurance, find out why.
Usually under an emergency situation most insurance carriers will pay. Perhaps the hospital did not code it as such.
If your plan was an HMO plan and hospital is not in the network, you may also have an emergency clause in this plan.
So call your carrier or look closely at the EOB from them and then try to fight the denial.
It is sort of strange that an emergency visit would not be covered by any insurance.
Good Luck!
Tricia
