How to get insurance company to waive Occurence/CoPay for multiple treatments at hospital?

Question
In November I saw a doctor on a Thursday who specializes in Naprotechnology in another state as this doctor is the only doctor who treats with this procedure. She diagnosed me with a problem with my ovary and needed me to have an ultrasound every day to see if my follicle would rupture or to make a diagnosis if it wasn't.  Usually, she would do the ultrasounds in her office but as I live 2 hours from the office it was not practical for me to return to her office for the follow up ultrasounds. I was on my own for setting up ultrasound appointments. I contacted the local independent imaging office but unfortunately, they weren't open on Saturday and Sunday and wouldn't be able to do my ultrasounds then (by this time it's Friday). I contacted the hospital and they stated that they could set up daily appointments for me but they stated I would be responsible for a $75 occurrence fee each and everytime I came in for the ultrasound. I asked the hospital and independent imaging office if I could maybe split my appointments, doing my ultrasounds in the hospital on Saturday and Sunday and having how ever many other ultrasounds through the week at their facility.  Both places stated that they could not do this as each facility has their own way of reading and interpreting the results and that if I started with one facility, so that my results would be accurate, I needed to continue with said facility.  This really put me in a bind as I needed to have the ultrasounds and it was already Friday so I needed to make a decision quick and go with it. I tried contacting my insurance company and explaining my situation to them. They didn't seem to care and would not budge. They stated that if I went to the hospital I would have to pay the $75 occurrence fee.

Not knowing what else to do and needing the ultrasounds I set up the appointments with the hospital and went for my ultrasounds all through the weekend. It turns out that I needed to have eight ultrasounds before a diagnosis was made.

The hospital sent me a bill for $600.00. I contacted the hospital and they were nice enough to contact my insurance company explaining why I had to use their services but the insurance company told them the occurrence fee still stands.  The nice hospital rep who contacted me back suggested I write an appeal to my insurance company.

I don't even know where to begin. Basically, I needed the ultrasounds and my doctor didn't care where I had them as long as I had them done. It was the facilities that stated once I started at one facility, for consistency sake, I needed to continue with that facility.

Is there anything I can do at this point? Anything I can point out to have this large per occurrence fee of $75 per occurrence waived?


Answer
Hi April!



You did go to the hospital 8 times for testing being aware that you would have a cost of $75 each time.  Your carrier did advise you up front.



You can always appeal with your insurance carrier if the hospital copay was more than a facility would have been stating that due to emergency you had no choice but to go to the hospital, explaining your reasons you gave me, and state them in detail stressing "emergency".  Sometimes if an emergency situation they will reconsider.  Worth a shot since you have nothing to lose.



Good Luck!

Tricia