Question
Arlene, New York
My father lived in NY and came to Maine to vacation with me when he suffered a massive heart attack. Blue Cross-Blue Shield is denying the hospital & ambulance claim because after he was admitted as an inpatient, they were'nt informed within 48 hours. He was hard of hearing, couldn't read english and would know very little about his health care coverage. I didn't have any of Blue Crosses literature with me on vacation, so I had no clue about this 48 hour notice and it certainly wasn't a top priority at the time!
My father passed away 2 days after being admitted and now Blue Cross is saying this claim isn't covered because of this detail. They are also telling me that there is no one named on his policy who would have power of attorney to appeal they're decision.
My mother is no longer alive, but, I am one of four daughters. What, if anything, can we do?
Answer
Time for a lawyer. You may have a good case.
Answer
They are also telling me that there is no one named on his policy who would have power of attorney to appeal they're decision.
Who is the Personal Representative of his Estate or the Executor/ix of the estate?
This person does not have to be listed anywhere, with the proper documentation that they are the PR or Executor/ix.
Answer
We have a lawyer who is executrix.
Answer
Arlene, New York
My father lived in NY and came to Maine to vacation with me when he suffered a massive heart attack. Blue Cross-Blue Shield is denying the hospital & ambulance claim because after he was admitted as an inpatient, they were'nt informed within 48 hours. He was hard of hearing, couldn't read english and would know very little about his health care coverage. I didn't have any of Blue Crosses literature with me on vacation, so I had no clue about this 48 hour notice and it certainly wasn't a top priority at the time!
My father passed away 2 days after being admitted and now Blue Cross is saying this claim isn't covered because of this detail. They are also telling me that there is no one named on his policy who would have power of attorney to appeal they're decision.
My mother is no longer alive, but, I am one of four daughters. What, if anything, can we do?
Ok, I have my dander up. If all is as you say, this is absurd. EMERGENT is the operative word. 48 hours even in an emergent situation may still apply, however, that will be 48 business hours. Are you sure that this provision does not simply apply to a penalty, vs. no coverage at all? Also, I suspect his BC/BS plan does allow for EMERGENT care even if outside of the network. Although not impossible, I cannot fathom that your father's plan does / not did not have provisions for EMERGENT care.
Although there are exceptions, you/family should have 180 days to appeal. (Although I have a good idea, I won't speak to whom may have that ultimate power.) Please read the plan, the time to appeal could be as short as 60 days. I cannot believe that an ambulance is denied. Oh my gosh, please do not sit down and let this happen. You can win, you will win. I promise, and I don't do that often. Having no clue of the plan language won't help you. Having a big clue of the plan language will help you.
I've never seen a plan worth salt that did not provide for EMERGENT care. Not that it is impossible, but, wow, really rare. If you appeal, do NOT focus on purely emotional or seeming rational. FIND FACTS in the PLAN DOC and in the medical literature to prove your father's situation was EMERGENT!
PS The attorney options mentioned above are certainly appropriate. I only suggest than with enough knowledge and voice, you may not need to get there. best to you lkc15507
Answer
Ok, I have my dander up. If all is as you say, this is absurd. EMERGENT is the operative word. 48 hours even in an emergent situation may still apply, however, that will be 48 business hours. Are you sure that this provision does not simply apply to a penalty, vs. no coverage at all? Also, I suspect his BC/BS plan does allow for EMERGENT care even if outside of the network. Although not impossible, I cannot fathom that your father's plan does / not did not have provisions for EMERGENT care.
Although there are exceptions, you/family should have 180 days to appeal. (Although I have a good idea, I won't speak to whom may have that ultimate power.) Please read the plan, the time to appeal could be as short as 60 days. I cannot believe that an ambulance is denied. Oh my gosh, please do not sit down and let this happen. You can win, you will win. I promise, and I don't do that often. Having no clue of the plan language won't help you. Having a big clue of the plan language will help you.
I've never seen a plan worth salt that did not provide for EMERGENT care. Not that it is impossible, but, wow, really rare. If you appeal, do NOT focus on purely emotional or seeming rational. FIND FACTS in the PLAN DOC and in the medical literature to prove your father's situation was EMERGENT!
PS The attorney options mentioned above are certainly appropriate. I only suggest than with enough knowledge and voice, you may not need to get there. best to you lkc15507
Okay, I give up. Your post is total gibberish.
Definitions of emergent on the Web:
* A plant growing in standing water with the terminal part above the water.
* The uppermost layer of the rainforest also known as the Dominants. This fourth layer consisting of the tops of the tallest trees.
* An aquatic plant having most of its vegetative parts above water. Also, a tree which reaches or exceeds the level of the surrounding canopy.
biology.usgs.gov/s+t/SNT/noframe/zy198.htm
* a plant that is rooted below the water but has foliage that extends out of the water.
museum.nhm.uga.edu/gawildlife/glossary/gawwglossary.html
* An individual tree growing higher than all (or virtually all, if in a clump) others in its vicinity within a forest, so that its crown rises markedly above the adjacent overstory.
oregonstate.edu/~mccuneb/glossary.htm
* as in an emergent property: one which cannot be observed locally in the subsystems, but only as a global structure or dynamic. We limit the usage to an emergent property or structure and not as an emergent system.
ishi.lanl.gov/diversity/Glossary1_div.html
* models of change emphasise that in uncertain conditions it is likely that the results of a project will be affected by unknown factors, and that planning has only a limited effect on the outcome.
wps.prenhall.com/wps/media/objects/213/218150/glossary.html
* macrophytes grow on water-saturated or submersed soils from where the water table is about 0.5m below the soil surface (supralittoral) to where the sediment is covered with approximately 1.5m of water (upper littoral).
lakes.chebucto.org/glossary.html
* Wetland vegetation which protrudes above the water level.
* a type of plant rooted in shallow water but supporting stems and leaves that reach and grow up out of the water; cattails and arrowhead are emergent plants.
* When referring to a plant: one rooted below standing water, but growing out of the water.
* protruding above the water surface (eg emergent vegetation).
* Refers to a property of a collection of simple subunits that comes about through the interactions of the subunits and is not a property of any single subunit. For example, the organization of an ant colony is said to "emerge" from the interactions of the lower-level behaviours of the ant, and not from any single ant. Usually, the emergent behaviour is unanticipated and cannot be directly deduced from the lower-level behaviours. COMPLEX SYSTEMS are usually emergent.
* Describes a property of a system that is not predictable from the starting conditions.
* in aquatic plants, one whose upper stems and leaves extend above the water’s surface
* A plant that grows directly in the water and stays erect to emerge from the water surface, regardless of the water level.
sherpaguides.com/chesapeake_bay/appendices/glossary.html
* Rising above the water surface from below it. Eutrophic - Water containing high concentrations of plant nutrients.
* refers to plants that have the ability to establish its roots below normal water level and project its leaves and stems above normal water level.
* living things which exist in two layers of an ecosystem, such as sedges, grasses, and other vegetation which emerges from the water
* occurring unexpectedly and requiring urgent action; "emergent repair of an aorta"
* coming into existence; "an emergent republic"
wordnet.princeton.edu/perl/webwn
* Emergence is the process of complex pattern formation from simpler rules. This can be a dynamic process (occurring over time), such as the evolution of the human brain over thousands of successive generations; or emergence can happen over disparate size scales, such as the interactions between a macroscopic number of neurons producing a human brain capable of thought (even though the constituent neurons are not themselves conscious). ...
en.wikipedia.org/wiki/Emergent