Question
What is the name of your state?
Georgia My insurance company is refusing to pay a claim for an out of network doctor, they paid the minimal amount allowed for out of network. My problem is that I was admitted to a trauma center through the ER and was in and out of conciousness, I had no way of deciding who my doctor would be. Just so happens he was out of network. Do I have any recourse? I have appealed through my doctor and the claim has been denied. The insurance company has now told me that it has been over 180 days and I cannot appeal anymore. The doctors office has now turned this debt over to a collection agency and I am being sued for the $24,314.00 outstanding debt. HELP!!!!!What is the name of your state?
Answer
Hi.....One of our patients had a very similar situation. They were in a car accident and flown to a trauma center which was out of network for their HMO. Since our Doc is their PCP, he called the medical director of the HMO and raised h*** with him/her about the situation.
In some states there is a law which requires insurance companies to waive their out of network policies if the patient is treated on a emergency basis. You may want to check that out.
Also...contact your PCP. They may already be writing you referrals for your follow-up care with the sub-specialists. Explain the situation, there is a chance that they may be helpful to you in contacting the insurance company. I can't guarantee anything, but it's one more thing to try.
Good Luck!
Answer
Thanks lealea1005 for the info, its sure worth a try.