Weeks later, I'm still going round-and-round with the insurance company over the paramedic call that they refuse to reimburse at anything near the 90% rate that they're supposed to pay for emergency services.
About a week and a half ago, I spoke with a woman who promised me everything; not only was she sending the full $300 claim back for reprocessing at the 90% rate, but she would call me back after the claim was processed successfully. Of course, she vanished into the aether — when I called today, not only was the claim not reprocessed, they had no records of me speaking to anyone on or near the date I'd called. Mischievous ghosts!
And now that the hospital stay has pushed us above a certain secret dollar limit, they've started getting picky about other claims, in addition to making 'errors' that always seem to work out in their favor — most recently, they processed an in-network doctor's claims as out-of-network, which, unless they reprocess the claims, is an $800 difference out of our pocket.
Dealing with the insurance company and its panopoly of secret rules, thresholds, and limitations is starting to feel a lot like playing in a card game where you can't see any of the cards. By mail.
[I've also found out more about how city paramedic services work in Orange County (at least billing-wise): Anaheim charges $300 for every paramedic response; any ambulance transportation on top of that is a separate charge. You can get the $300 charge waived if you join the $3/month 'Ambulance Subscription Program' (now that we know about it, we have). All of the cities surrounding Anaheim have a similar policy, charging anywhere from $82.50 to over $700 for a paramedic response. None of these cities have a mutual you've-already-paid-over-here arrangement to waive these fees — so while we may be safe in Anaheim, getting hurt anywhere else in Orange County is likely going to cost us a damn sight more than the $51 'prevailing charge' that our insurance company uses as their ceiling for paramedic charges.]
Posted by Kevin at September 7, 2005 03:42 PM