Insurance wants to deny ER visit.......

[Lil E]

Because I was "pleasant and quiet" with '' no signs or symptoms he could see".
Guess I should have been screaming, crying and dragging myself in by my lips! :eek: Its mainly because they know me there and the doc didn't put down that I had DDD with previous surgeries.

They say I could have seen my PM for it. Now I have to explain that you can't get the shots I get in a doctor's office and if you throw a fit in an ER they toss you out. They probably didn't even look at my previous visits that they've been paying for over the last ten years. :mad:

[moose53]

((((((Lil E)))))),

http://img.photobucket.com/albums/v90/moose53/MINIS/HUGS/huggiebears-mini.gif

It's bad enough that they have to treat us like "it's all in our heads (fibromyalgia)" for over two decades ... now you have to jump through hoops like a circus tiger :mad:

G-d, the bologna slices are getting thicker and thicker, aren't they :mad:

Do you still have receipts for all the prior visits that they paid for?? If you do, or if you can get copies from your insurance company or your employer or even from the hospital, it would probably go a long way toward your being able to appeal the decision and get the visit paid for.

It's just so idiotic, isn't it ... if you throw a fit in the emergency room, you're likely to get thrown into the psychiatric hospital.

I hope you get this resolved. You SHOULD NOT be having to deal with this on top of fibro and all the other crap in the world.

Hugs. Good luck.

Barb

[steph2323]

This is so irratating that we get we have to jump through so many hoops to get treatmen.He must of put a reason for giving shots on the note, like a pain level for instance, to justify his action. Did the insurance company give you a copy of the entire doctors note? I would request that to see what is in the note, and then report them to the insurance commision in your state. Good luck
Stephanie

[Mark N]

LIL E, did they give you another alternative for your injections? I know their concern is the high cost of ER so they should give you another option like a
24 hour clinic. I hope you can talk to them and get things worked out as our life has enough problems without adding to them.

[Pharmacist.steve]

Because I was "pleasant and quiet" with '' no signs or symptoms he could see".
Guess I should have been screaming, crying and dragging myself in by my lips! :eek: Its mainly because they know me there and the doc didn't put down that I had DDD with previous surgeries.

They say I could have seen my PM for it. Now I have to explain that you can't get the shots I get in a doctor's office and if you throw a fit in an ER they toss you out. They probably didn't even look at my previous visits that they've been paying for over the last ten years. :mad:

Most insurance companies based their pay/no-pay on if it is outside of normal doc office hrs and the patient considers the symptoms "life threatening or potentially life threatening" since the average patient is NOT a "learned healthcare professional"... including such phrase in your appeal.. will make the insurance hard pressed to deny the claim on appeal.

The easiest (& cheapest) thing for the insurance company to do is say NO!/DENIED!... they know that at least 50% of the people will GO AWAY...

If your insurance is thru an employer - or spouse employer - get the HR dept involved.. if the company is large enough... they could be self-insurer and have a much larger latitude to tell the insurance company to pay it.. since the "insurance company" is nothing more than a "claims processor" for the employer

Also .. the insurance company has to tell you what your appeal rights are and how/who to contact... if you ask .. they are not required to volunteer the information... so they don't.

[Lil E]

Thanks guys! We're on COBRA due to my DH's stroke. They say that they have a "doctor" who reviews the claims. Even if I had called my PM he would leave it up to me whether to go to the ER or not. I don't know any doctor that gives opiate shots in the office.

[Pharmacist.steve]

IF these shots are a "regular thing" ... has anyone considered getting your doc to write you a Rx for the meds to be filled at local pharmacy and you keep the vial and take it to the doc office to get the shot? and/or also have your doc make arrangements with a local walk-in clinic to get the shot - if it is outside of your doc's normal office hrs.

[Lil E]

I go more often to the ER during the winter, the cold tears me apart. No one will let me give myself 3 to 4 mg of dilaudid I.M., at home and I never know when it will happen. I have never heard of anyone getting that kind of thing at the doctors office because they don't keep it, don't want junkies breaking in. And you have to be monitored for at least 30 minutes after.

[Pharmacist.steve]

I go more often to the ER during the winter, the cold tears me apart. No one will let me give myself 3 to 4 mg of dilaudid I.M., at home and I never know when it will happen. I have never heard of anyone getting that kind of thing at the doctors office because they don't keep it, don't want junkies breaking in. And you have to be monitored for at least 30 minutes after.

I did not suggest that a patient give the shot to themselves.. but to have the medication on hand.. purchased via RX at the local pharmacy ... to take to the doc's office - or immediate care clinic - to get a healthcare professional to give the shot. This would eliminate the doc having the drug on hand.. would eliminate fighting the insurance over a ER visit cost while allowing the patient to have their medical needs met .. in a timely basis...

[debhun]

The Heath care is the pits any more. It is going down hill fast. Why cause they want more money and they are told what they can do and not do. Just in the last 2 months or so I can't believe what has happen.
1. I went to the ER on my Dr orders cause I call him and told him what was going on and he told me to get there NOW not later but NOW. He thought I may have been having a heart attack. Well I get to the ER BUT I WAS NOT IN DISTRESS they didn't call me back for 30 mins. I could have died in the ER waiting room. All Cause they look at you and see how you are acting. Look I hide my pain. cause I had to cause of my family. but you can see it in my eyes when I am in pain. I have bite my check so many times cause of my pain. But that wasn't the last time the health care as failed.
2 My Dad had a gall bladder attack .they but him in the hospital then 2 days later sent him to Pitt Hospital. They only gave him Meds and had a very bad Attack in the hospital. They didn't do nothing but meds told him he had to wait till the swelling went down sent him on 4 days later. her was home a week and got very very sick could not stop upchucking. Had Mom take him Back to ER at Pitt. He was in ER for 20 hours. No rooms. When they did get him to a room the did a cat scan and found that it had burst. But it sealed itself off and was pressed next to his intestine's. They put a tub in his side and got over 300 cc of gangrene pus. Then send him home. now 2 weeks later they took the tube out this past Thursday. Sent him home till the 14th then they will do test to see if they can take it out.
My dad should be dead by the gall bladder busting. But by Gods Hand he saved him.

3 Now Hubby Dad had a heart attacks and the same thing is going on. they will not fix it till later. But he can't go home. He will go to rehab till they can do the by pass.

4 My Aunt has hurt her back and has been in pain for 3 weeks now. Her Dr gave her a sheet after she had a MRI and told her to pick who she wants and call and make appt. I have never heard of the either. My Dr always called and made the appt for me cause you have to be referred. God only knows what will happen with her. She had to go to the ER the other night cause of her pain. She is not for meds. when she has to go to ER she is in Hello of pain.

So tell me what is happing with health care?

Sorry Lil E I didn't mean to take your post over. But there is no reason why they couldn't help you. that is why they are they for. You had a medical trouble. So Why do we Have to act like a fool to get help?

Deb

[Lil E]

A doctor wouldn't give you the med to keep at home, its too easy to get syringes. I get them from my vet for my allergic dog.

[Pharmacist.steve]

A doctor wouldn't give you the med to keep at home, its too easy to get syringes. I get them from my vet for my allergic dog.

And just what is the BIG DIFFERENCE between providing a "pot full" of a oral opiate and providing a patient with a via of an injectable to be used in the doc's office or under a pre-arrangement with a immediate care center?

I just filled one Rx today for 120 tabs of Oxycontin 80mg for ONE PERSON for a month's supply.. and this is less dangerous than one single dose or one multi-dose vial for a patient to hold on to... as opposed to having to fight the ER and their insurance to get therapy that their primary doc is aware of and would otherwise prescribe for the patient!