Can Anthem Explain This?
This was freely shared (and found) on the internet. It is not from my family:
My daughter’s 8 day hospital stay for pneumonia and RSV where she was nearly admitted to the ICU has been denied a WEEK AFTER she got out of the hospital. For non Americans I’ll have to pay for this of pocket. Cost is astronomical
My daughter required oxygen the entire time and I was told by several nurses that she was their sickest patient on the floor and at one point the risk team wanted to transfer her to ICU for high flow oxygen. This has been deemed medically unnecessary by the team at@AnthemBCBS
Oh and she was on IV fluids bc she wasn’t able to drink or eat for a week. Also low electrolyte levels.
If this is true, and I have no reason to doubt it, then this is criminal. Here are my questions:
- How can Anthem deny any hospitalization and stick a patient with a bill? The patient is not in charge of his or own care when they are that sick?
- Why was this done a week after the hospital stay?
- Who will fight for the patient? The doctor? The hospital? Or will they stick the patient with the bill?
This insurance model is so broken right now. I will soon show how Cigna is denying claims over and over again. I just wanted to give this case more attention so we can embarrass these insurers and shine the light on their atrocities.
Don’t know about KOM, but this is a good candidate for a NPR-Kaiser Health News bill of the month. There is a whole series on this and it’s amazing how fast the wheels seem to move once the insurance company/hospital get a call from the media
Appeal. Then take the overturned appeal to the state insurance department.
Doug, just glad your daughter is okay. What a hellish thing for a parent to go through. I’m fairly confident that you’ll work the rest out but it will take time and patience. Shame that you have to eat up your time haggling with the insurance company.
Let me clarify, this is not mine but found on the internet
Don’t accuse me of siding with an insurance company here, because I hate them all with a burning passion, BUT,
In all likelihood, some “billing expert” with an associates’ degree in Medical Coding sent the bill out coded for PNA, but before any codes were added for anorexia, dehydration, hypoxemia, or hypoventilation.
Once the hospital re-sends the claim, with the proper codes, it will be paid.
But only if the hospital DOES, in fact, resubmit the claim, which it won’t do without the affected person yelling and screaming at them.
In the final analysis, of course, this is a completely stupid aspect of a completely stupid system, which will sooner or later implode, but that’s a separate discussion.
There are certain cases or insurances, where you have to send a clinical note with the bill in order to get paid.
We went through this years ago. Payment rejected by insurance because “you did not send a clinical note” when you know you did.
So we would take the clinical note and staple it to the billing form.
Insurance company would send a rejection, saying we did not send the clinical note.
But the insurance returned a copy of the billing form we sent them.
You could see the staple at the upper left corner of the billing form.
So, yes, I understand what you say.
But the insurance companies just out-and-out lie.
There’s no two ways about it.
a$$holes!
Obviously, they don’t know who they are messing with.
Rumor has it that KOM has a particular set of skills…
LOL
Would like to see the ultimate outcome on this. It’s unequivocally wrong and is the worst example of Monday morning quarterbacking where lives are at stake. Many states (don’t know about Virginia) stick the hospital with this and they are prohibited from balance billing the patient.