Just heard back from the idiotic Cigna person who said it should all be taken care of now. I hope so. She said it's been properly coded as an emergency. Um, ok. I didn't argue with her. I guess it was sort of urgent--a bed opened up and dd needed transport. But emergency? Not really. Whatever. But it doesn't give me confidence that this is really the end of it.

Unfortunately, the hospital case worker is no longer a case worker. She's still there, but is doing therapy now, not case work. She was nice enough to email me back various contacts and phone numbers and information she had, but no, I couldn't ask her to deal with the insurance company. But the ambulance person said she'd be willing to get on a 3-way call with me and cigna. I'm waiting to hear back from the cigna case worker. Glad it sounds like yours will work out.

Do you think that hospital case worker would go to bat for you?  Seriously, with all you're having tongi through financially for this, you need them to work things out for you.

Well, my ambulance company sent the medical records and it's been sent back for reprocessing. I assume things will work out for us.

So far:

Hospital says that Cigna said "use company X for ambulance because it's in-network, so no authorization is needed." But no actual record of this.

Ambulance co says Cigna rejected claim because they don't cover transport at all. Cigna told me that at first, but then said it wasn't covered because there was no auth. Ambulance co is checking to see if auth is needed with cigna.

I have a call into the case worker at cigna who was in charge of this to see what the actual reason for the rejection is and to see what she says about needing an auth. But I've dealt with her before and she's a total idiot. (She's the one who tried to tell me they don't cover any RTCs at all in my state, which isn't true.) So we'll see.

Bottom line is that there is no way I could have gotten authorization--I wasn't involved. A bed opened up at hospital 2 and hospital 1 arranged for transport.  Even if I had said "hey wait, let me call cigna and make sure all this is covered" I KNOW the hospital case worker would have said don't worry, we've taken care of all that and it's covered. I know she would have said that. She was constantly telling us don't worry about insurance. We are dealing with that.

Sticking this here. It's what I was looking for

http://www.ncbi.nlm.nih.gov/pubmed/22712745


Some pretty scary features in that survey, particularly for those of us with older kids that don't present with typical anaphylaxis.

Oh no! 

Yes, they should have done that.

When I called my insurance company, the ambulance company hasn't called them.  I'll call this coming week. I was sick and last week I had so much to do for my mom. But I'll get back to it this week. Not looking forward to talking with that man again. Really not.

Did you get it taken care of? I'm chasing mine now. Insurance didn't pay for the hospital to hospital transfer back in November for dd. Insurance had stopped paying for hospital #1, but agreed to pay if we moved her to hospital #2. They didn't pay for the ambulance because they said it wasn't pre-authorized. I'm not really sure what to do. I had nothing to do with it. I didn't arrange for the ambulance. The hospital ordered it. If it needed to be pre-authorized, they should have done it. They were certainly in close contact with the insurance company during all this. I've contacted the case worker at the hospital to ask her who I should talk to about this. I'm hoping there's some documentation about the transfer being authorized and something about how dd would be transported.

You're darn tootin' right.

Actually, I know I've seen on twitter in the last few months one of the allergy docs post something about a study of ERs and anaphylaxis.  About protocol a d it NOT being followed. I was trying to find that. Clearly my ER follows protocol fairly well.

Yesterday I called my insurance to see if things had been faxed. Nope.

Ugh.

Completely off topic of this off topic subject -- when we were in ER waiting room with son and possible ana reax, I was at intake desk trying to get the intake person to give us some priority and up strode some "I know everything" doctor (had on hospital ID but was NOT on duty) who insisted that

unless my son had obvious breathing difficulty,

he was most def NOT in anaphylaxis.

(Son had vomiting, hives, and impending sense of doom . . .  was exposed to unknown something at school)

That was 2009.


(I nearly choked the guy and then he would have been in asphyxiaxis -- word made up).


That was in big name hospital in supposed big name state with whoo-wah medical.


~ ~ ~

My point being,

DEFINITION of ANAPHYLAXIS and

RECOGNITION

and

TREATMENT

needs some gosh-darned standardization and there needs to be BIG ed push as to medical care:  FARE?

This is where your language in all communications needs to be VERY FIRM.

You have them, but I get you want them to be educated as to def of anaphylaxis.

Get your bill paid first via insurance.

Make the education as to anaphylaxis secondary -- once you have primary care doc and/or allergist who might help.

Looks like FARE needs to be onto things once dust has settled -- bring this whole situation to their attention and get them to do campaign as to def of anaphylaxis . . . not just for epi treatment but for standard insurance coding . . . after appropriate care!

Be sure you miss no deadlines for any requests for review and/or disputes of nonpayment so far as your insurance.  Missing any deadlines/gates is typically non-negotiable.

I have no advice, but I am disgusted with that guy for acting like he knows better. I hope you get some resolution soon, because that is a ridiculous amount for them to expect you to pay.

 A couple of things from a friend who used to do health ins....

If the emt isn't responsive, talk to the emt's suprerior in regards to getting it coded differently - any code that shows you couldn't have used other transportation will work (i.e., you were not using the ambulance as a cab)
Copy of dr's orders about what to do if you epi
Copy of er's diagnosis and the fact they re-epied you

In Pennsylvania, a trip to ER after epi has to be via advanced life support. Basic life support ambulances do not carry epi. It's even on the boys' action plans to call 911 and request ALS.

Last reaction we had both show. Symptoms were much improved by the time they arrived and they basically drew straws in the front yard to see who had to transport us. Literally. While a stood there holding him and waving our AP at them.

Be a squeaky wheel McC.  If you don't get anywhere with the fire chief faxing, tell the insurance company you want to pursue a formal appeal. It involves you stating your case (over the phone) while you're recorded.  Good luck!

Holy cow that is a lot.

Its $45 here if its medically necessary and $240 if its not. 

No advice, except to have the ambulance company change the code, which they can do.  they certainly can re-submit with *proper* coding.  But you have tried asking for that.