Question
I was admitted through the ER for a collapsed lung, surgery the following morning. After months of fighting with the hospital and my insurance company I now find out because I didn't call to ask permission to be admitted that the benefits were reduced by 50%. I've now read thoroughly my benefit plan, which I should have done previously, but what recourses do I have if any? I was heavily sedated, had a chest tube and was unable to call to ask permission to be admitted. The hospital did not notify me that benefits would be reduced. All charges for surgeon, other physicians, ER, ambulance, etc. have been paid at 100% or 80% except the hospital. Aren't they supposed to do that when they verify benefits when admitted? I have appealed it twice to the insurance company but they insist because I didn't call they will not reconsider. Help!
Answer
Hi Vicki!
There are usually exceptions if you are unable to call for authorization which sounds to me you were not able to. Look for a clause in your policy on this.
And yes the hospital should have called prior to you being admitted. Call them to see why they did not call for authorization. Perhaps if they take blame they will accept the 50% coverage.
Good Luck!
Tricia
