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?
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!! (http://foodallergysupport.olicentral.com/index.php/topic,6514.0.html)
Quote from: Macabre on December 11, 2012, 05:59:40 PM
(http://i20.photobucket.com/albums/b205/McCobbre/2E344943-6D53-49D3-8AC7-8855A185CE27-3311-00000378D269546C_zps723adae5.jpg)
(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.
Quote from: Macabre on December 12, 2012, 07:30:46 PM
Had abdominal cramping most of the day--intestinal and uterine. Ugh. I'll dose with Benedryl tonight when I don't have to drive.
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.
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?
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).
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.
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?"
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?
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.
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.)
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."
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.
is it the difference between the EMT coming vs. paramedics?
Quote from: Macabre on April 02, 2013, 01:41:56 PM
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.
Time to put the batsignal up for FARE? They have seemed more with it than in the past and historically even FAAN showed strong advocacy for EMS compliance or legislation.
That's exactly what I'd love to say. :yes:
Instead, I left him a voice mail asking him to fax my records, which I believe indicated an allergic reaction, to the insurance company. I volunteered to pick them up and fax them myself (and of course, part of me would much rather do this--I want to see what he says.
I do hope this is mostly over with. I left my number. I said I'd call back tomorrow to see if they'd been able to take care of this.
Doesn't the epi instructions say to seek medical attention immediately? Are you supposed to wait for a cab to be dispatched.
The last time I used epi, the EMTs asked me if I wanted to go to the hospital. (I was pretty symptom-free when they showed up except for just a few hives.) I told them that while I would rather not, it's doctor's orders that I go by ambulance.
The hospital docs were much better about it.
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.
Holy cow that is a lot.
Its $45 here if its medically necessary and $240 if its not.
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! :heart:
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
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.
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.
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????
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.
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.
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.
Sticking this here. It's what I was looking for
http://www.ncbi.nlm.nih.gov/pubmed/22712745 (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.
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.
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.
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.
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.