Denied Claim on Hospital Emergency call
Gil Gulbrandson
Description
Collection
Title:
Denied Claim on Hospital Emergency call
Creator:
Gil Gulbrandson
Date:
1/2/2008
Text:
Hello all,
Perhaps many of you have had this happen, however it is the first time for me. In August I received a call from our local hospital for a Halo. The patient had been drinking and driving when he ran his car into a house, fracturing C3,4. I provided the halo for my local ortho referral and the halo was applied that evening. My contract with the hospital required us to bill private insurance directly, Medicare obviously being billed to the hospital. This 22 YO male had private insurance. After review, which took until last week, it was determined that the insurance company denied payment because the patient was impaired due to substance abuse. Evidently this was a clause in the patient's insurance policy. No way for us to preauth this due to the emergency of the situation. We are going to bill his car insurance but as you may know, there is usually a cap on medical payments w/ car insurance. Bottom line is we are reevaluating our hospital contract. It becomes a roll of
the dice w/ these private insurance cases when you don't have the opportunity to pre-auth the case. Any thoughts on this or options we may have beyond billing directly to the patient which I have done but will probably end in futile legal action. Suggest we all reeval our hospital contracts from time to time.
Gil Gulbrandson CO
---------------------------------
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Perhaps many of you have had this happen, however it is the first time for me. In August I received a call from our local hospital for a Halo. The patient had been drinking and driving when he ran his car into a house, fracturing C3,4. I provided the halo for my local ortho referral and the halo was applied that evening. My contract with the hospital required us to bill private insurance directly, Medicare obviously being billed to the hospital. This 22 YO male had private insurance. After review, which took until last week, it was determined that the insurance company denied payment because the patient was impaired due to substance abuse. Evidently this was a clause in the patient's insurance policy. No way for us to preauth this due to the emergency of the situation. We are going to bill his car insurance but as you may know, there is usually a cap on medical payments w/ car insurance. Bottom line is we are reevaluating our hospital contract. It becomes a roll of
the dice w/ these private insurance cases when you don't have the opportunity to pre-auth the case. Any thoughts on this or options we may have beyond billing directly to the patient which I have done but will probably end in futile legal action. Suggest we all reeval our hospital contracts from time to time.
Gil Gulbrandson CO
---------------------------------
Never miss a thing. Make Yahoo your homepage.
Citation
Gil Gulbrandson, “Denied Claim on Hospital Emergency call,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/228895.
