I sometimes mistakenly refer to EOB’s as Evidence of Benefits, instead of Explanation of Benefits (what it actually stands for). They honestly don’t seem to explain much, except for how far the US has to overcome if it plans to move forward in providing quality health care. One of my favorites is that all of the recent EOB’s we have received, state that our deductible has not been met, but it doesn’t say how much it is, or how much has been applied year-to-date towards it.
I fear we may be in for a fight with B’s emergency room visit. The insurance company has requested records from both the hospital and apparently B, although he has not actually received the official letter. And because the part of the company that deals with these issues is on the east coast, no one in the office could access the letter at 3pm in the afternoon Pacific Time. How is this helpful?
So much of insurance billing really comes down to how things are coded. There are weekend seminars where people learn how a few changes can make a huge difference in the income of a doctor’s practice. In this case, it looks like the ER may have coded what is listed as emergency care – non-emergency. Now this could be a ploy to get more money, as if the care is denied, we could be on the hook.
The truth is though, that when a doctor at the Urgent Care Center says you could die, and your blood pressure is not going down, who would get into their car and just drive home? Does this seem like a reasonable response? Should he have called a cab?
And of course, there is also the matter of the ambulance. In theory, since they are an Urgent Care Center and regularly transfer people to the hospital via ambulance, they should now to call and get authorization. For those unaware, most insurance companies have someone called the ambulance coordinator whose job is to approve all ambulance transports. The real question is when something like a car accident occurs, at one point would someone call? And again, what reasonable person wouldn’t agree that if you were unconscious at the scene of an accident, you needed to be transported to the hospital via ambulance? Still, it seems like all these cases are automatically denied.
on the night stand :: The Incorrigible Children of Ashton Place: The Hidden Gallery by Maryrose Wood