Chasing my ambulance bill

[Macabre]

Ugh.

Remember the reaction I had in December?  Well, I am trying to work through things with my insurance company and the providers.  I am really frustrated, and I need some help.

First, I need some help finding the thread where I described my reaction.  I've not been able to find it with the words
Amy's

• sesame by Macabre
• reaction by Macabre
• SOP byajasfolks2 (I remember she wrote that in response to the second dose of epinephrine)

And then I need some help with strategy.

My insurance won't cover the $1400 ambulance bill (I live 1.4 miles from the hospital) because the ambulance company didn't use the right code to indicate urgent care.

The ambulance company said the notes on my file don't indicate urgent. Don't indicate anaphylaxis. I didn't have hives or shortness of breath . . . . (actually, I did have shortness of breath--it was one of the reason I Epid). 

I talked with the assistant fire chief about my reaction, said I was experiencing two or more body systems after ingesting sesame directly, and per my doctor's instructions, I epid and called for transport.

The ER has described the event as anaphylactic. The ER physician's bill was paid at 100% (I've only had to make my ER copay), and what they wrote indicated anaphylaxis.

The ambulance company is not interested in:
1) the ER's diagnosis, because what happened in the ER and what happened with the ambulance are two different things
2) learning about how the AAAAI defines anaphylaxis because "Ma'am (isn't that sweet he used that term up here), I've been doing this for years. I know what anaphylaxis is." (Of course, earlier he said "You didn't have hives.")

He thinks I'm asking him to change a "legal document." Um, no. I'm asking him to correct his files. He said he won't change the code just so my insurance will cover this.  I told him I am not asking him to falsify anything; I am asking him to put the correct informtation in the files.

He said, "You didn't have anaphylaxis."


Is he a physician? No.  Did he see Serum Tryptase results?  No.  (The ER didn't take them, and he's not interested in the attending physician's diagnosis anyway.)

How is he qualified to diagnose anaphylaxis?


Ugh. So I am between allergists.  I don't even have a primary care physician yet. 

I have no doubt that I will win this. 

No doubt. 

But wow--I do not have time to deal with this battle.  But I will engage. 

I know I wrote a fairly detailed account of the reaction.  I can't imagine I'd put it in V&D.

I'm keeping this here because I don't want it public, though if there are helpful tidbits, I will redact later and put it in Main--if it would be helpful for others. 


Ugh--help me friends.  Ideas for strategy--or finding my thread?

[Macabre]

Okay--found the thread. That was quick--once I just started looking in OT by date.

What did I do this afternoon? This picture says it all!!

[Macabre]

(Click to enlarge.)

Guess who did not even glance at the well-labeled box?

Within 20 minutes:
-Runny nose (not horribly), watering eye (left nostril and left eye)
-Tight chest and slight difficulty breathing
-Spaciness
-Itchy skin

25 Mg of liquid benedryl

Then called DH who started on his way home (from 20 miles away) and felt the following:
-Hands felt tingly and without strength
-Eustachian tubes felt swollen
-overall sense of malaise (and maybe impending doom?)
-chest still tight

Went to the bathroom and noticed I had started. Joy.

Changed pants and shirt because I wanted to wear something else to the hospital.  Sent an email to colleague that I was about to Epi and go to the hospital.  I was having a difficult time being coherent. Closed my laptop.

Called DH and told him how I felt. He stayed on the phone with ne while I Epid. Reminded me to rub (totally forgot that, and it's not like we've never done this.)

I called 911 and lay down and put my feet up. I did get my purse, keys and briefcase. 
This is my busiest week. Unlocked the drone door. Three paramedics came in.

I felt so strange. I know I wasn't speaking clearly. I remember mispronouncing the word "weird" and said "fierd". But the paramedic said I was forming complete sentences and was doing okay.

The ambulance arrived at the hospital inside. Inside!

Good thing because it was around 15 degrees.

I got a second dose of Epi. It is apparently standard protocol along with pred and Zantac.  But before they gave it to me I felt my hands go weak again and started feeling icky. Felt better afterswcond Epi.

I am home. I am having some uterine contractions, like I did (for 4 days) when I had to Epi in 2006.

I do.not.get front menstrual cramps--just back ones. But I'm guessing this is both rxn and period related. That is, I wouldn't be having this if it weren't for the rxn but the fact that I am on my period made the uterine stuff more likely.

Ugh.

This is not something we need to have pay for while making two house payments. Lovely. I always read the labels but didn't for some wild reason.

I'm so angry at myself. Ugh.

We can move this to Reactions after a bit. Just wanted more visibility.

Had abdominal cramping most of the day--intestinal and uterine. Ugh. I'll dose with Benedryl tonight when I don't have to drive.

[YouKnowWho]

So the ER classified you as having anaphylaxis.  Start with insurance company and say even though ambulance says it wasn't, qualified physicians at the ER did.

[twinturbo]

What's previous allergist's office staff like? Friendly? Ask for a copy of EAP to submit and consider escalating after EAP is received. Funny wow not funny haha story about my friend who by trade was a hospital insurance auditor had her own insurance initially refuse to pay for a tumor removal. What was the alternative there? Leave it as a keepsake?

[Macabre]

I don't have a written plan for myself--just for DS.  My doctor was comfortable with my understanding of the plan we went over verbally. Frankly, written plans since DS was past a certain age have been more for the school, yk? 

I haven't been to my allergist at Duke in  . . .  hmmmmm . . . several years. I've gotten my epi script through my primary--who moved last fall (after we did). 

[BensMom]

Ok, first of all, how is a 1.4 mile trip $1400?? I have an ambulance bill for $900 for transporting dd from one hospital to another and it was a 41 mile trip. Base rate was $360, plus $12/mile. In my case, insurance didn't cover it because it was no necessary. I told them it was for a hospital transfer they approved and that it was necessary because dd was deemed unsafe to travel by car. The insurance person said "oh, I'll resubmit it then." I guess she changed the code??

Can  you tell the ambulance company that you won't be paying the bill since they refuse to code it correctly? Clearly if the ER says it was anaphylaxis, then transport was urgent. It really doesn't matter if the ambulance driver thinks it was or not.

And as YKW said, tell the insurance company that the ER said it was urgent.

[Macabre]

Ah! Good question!

Description of Charges	Quantity	Unit Price	Amount
Advance Life Support 1	1.0	1375.00	1375.00
Mileage	1.4	21.00	29.40

(So the total is actually $1,404.40. I had fudged it a bit.)


I wonder of "Advance Life Support" is a standard deal? Is there "Regular Life Support?"

[twinturbo]

Yeah, what BensMom said. That is a steep price tag.

Edited to add: Yeah, what Macabre said. If you didn't need Advanced Life Support why were you charged for it?

[BensMom]

My bill says BLS N/E BASE RATE.  BLS--basic life support? N/E--non-emergency? That could be the difference in price, but still--wow.

So this was a private ambulance? Is that what shows up when you call 911? In my state, I think they passed a law saying they would charge people an ambulance fee, but that if the insurance company didn't pay it, they wouldn't bill you for it.

[BensMom]

Maybe you can ask then what's below advanced life support and tell them that since they think it wasn't urgent, you're not going to pay the urgent price. If it wasn't urgent, you could have just waited for a non-urgent ambulance (our wait was 5 hours.)

[Macabre]

It's city owned.

I just spoke with insurance.  Hmmm.  This might work.  She said that they don't have to have the code changed, but they do need medical records from the ambulance company saying I had an allergic reaction. 

OMG.  The ER says that.
But I think the ambulance company will say that. They're just not going to say it was anaphylactic.

Mostly--like 99.9%--of me only wants this to be cleared up so that my insurance company pays this. But that other little part--it wants the assistant fire chief to acknowledge that his records may have been wrong. 

He was such a jerk.

You know--I want him to actually be able to recognize anaphylaxis. It's mission critical for him to not equate it with hives.






"Advance Life Support" begs the necessary question, doesn't it?  If I wasn't having anaphylaxis, why advanced?


I do remember thinking the EMTs weren't quite getting it, though.  I had a hard time forming words correctly--and thoughts.  And they kept saying, "You're just fine."

[Macabre]

Also, when I spoke to him, he said, "The notes said you were doing fine." Well, egads, I had already had epinephrine.  Of course it relieved symptoms.

[hezzier]

is it the difference between the EMT coming vs. paramedics?

[BensMom]

Also, when I spoke to him, he said, "The notes said you were doing fine." Well, egads, I had already had epinephrine.  Of course it relieved symptoms.

Call him back and ask him if you should have waited until the epi wore off and you were not fine to call the ambulance? And when he says he's been doing this for years and knows what anaphylaxis is, tell him you've been dealing with it for years and have actually experienced it, so you really really know what it is. Sheesh.