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Thread: I had a pretty bad crash last summer... (video)

  1. #73
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    Re: I had a pretty bad crash last summer... (video)

    didn't you listen? Cheeto lives matter damnit!

  2. #74
    Senior Member Clovis's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Just to clarify - my insurance plan had a maximum out of pocket of $6000 for the year, which we hit.
    (My daughter broke her arm in Feb which was $3000 and this accident was another $3000).


    The problem is, the max out of pocket doesn't apply to out of network billing. If the provider does not have any contract rates, there is nothing saying they "have to accept $XXX" for it. So they can bill whatever they want.

    So last year, our actual paid out of pocket was $6000 in addition to the $21,000 premium itself.

    $21,000 + $6000 in deductibles to insure a healthy 35, 32 and 2 year old... sounds legit. More like sounds like we're subsidizing the hell out of the baby boomers that have utterly screwed our generation.
    "If not us, who? If not now, when?"




  3. #75
    Senior Member Clovis's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Forgot to add - the helicopter did not save my life in this instance. My injuries were only broken bones and they didn't even operate until 60 hours later.

    All the helicopter ride did was financially screw us. I would rather have had someone ASK me.
    "If not us, who? If not now, when?"




  4. #76
    Gold Member bulldog's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by Clovis View Post
    Just to clarify - my insurance plan had a maximum out of pocket of $6000 for the year, which we hit.
    (My daughter broke her arm in Feb which was $3000 and this accident was another $3000).


    The problem is, the max out of pocket doesn't apply to out of network billing. If the provider does not have any contract rates, there is nothing saying they "have to accept $XXX" for it. So they can bill whatever they want.

    So last year, our actual paid out of pocket was $6000 in addition to the $21,000 premium itself.

    $21,000 + $6000 in deductibles to insure a healthy 35, 32 and 2 year old... sounds legit. More like sounds like we're subsidizing the hell out of the baby boomers that have utterly screwed our generation.
    I'd fight it with your insurance company...this was a emergency situation and in those cases they cannot penalize you! The fight is not with the helicopter company, but to the insurance company who processed it as out-of-network for a emergency.....that article I posted is how he won his.

    You get them to switch the "out-of-network" then you can claim your out of pocket.

    Remember a insurance company will always try to pay out the least amount in hopes people just deal with it.....appeal, appeal, appeal that company. it's worth a shot man! Differs from state to state, but at least try!

    Read this:https://fairhealthconsumer.org/reimb...red-in-network
    Situations When You May Need Care from an Out-of-Network Provider
    There may be several situations when you may need out-of-network care and can get it at the in-network rate. These situations may depend on your plan, or on the laws in your state. For example:

    • You have a rare, serious sickness or health problem, such as a genetic disorder. You may have to leave your network to find a provider who is qualified to treat the rare condition.
    • You live in a remote area where the network is not adequate to treat your serious condition.
    • You have an emergency, when you need care right away for a serious sickness or injury. You may need to go to the nearest emergency room, even if it is not in your network. (See Emergency Care and Urgent Care.)
    • You are already being treated by an in-network doctor for a serious condition. Then, you switch to a new health plan and that doctor is not in the new plan’s network. Or your plan stays the same, but the doctor leaves the network. You may be able to keep seeing the doctor at the in-network rate for the duration of the treatment.
    • Natural disasters can force you to evacuate to places where you need care outside your network. If the state or federal government declares a state of emergency, you may qualify for in-network rates.
    • If your child moves away to college and you want him or her to be able to see doctors close to the college, your plan may offer a guest membership. That would allow your child to be a “guest” of a network of doctors in that area. Similarly, some plans have “travel” networks to cover you when on business trips or vacations.

    Many states have laws requiring plans to cover such out-of-network services at in-network rates. If you need to go out of network, check with your insurer and follow the rules that pertain to your state and plan.

    P.S. Article even shows how to take action......by appealing decision!

    Quote Originally Posted by Clovis View Post
    Forgot to add - the helicopter did not save my life in this instance. My injuries were only broken bones and they didn't even operate until 60 hours later.

    All the helicopter ride did was financially screw us. I would rather have had someone ASK me.
    Yes, but at the time, they did not know that....would only know after they started treatment. In a severe accident like that, they have no idea if there is internal bleeding. This is what you fight the insurance company for.....demand it was a emergency and matter of life and death!
    Last edited by bulldog; Mon Apr 10th, 2017 at 02:25 PM.
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  5. #77
    Gold Member bulldog's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    This should help understanding the insurance appeal process: https://fairhealthconsumer.org/reimb...ement-decision

    Even if they deny the first attempt, keep trying:

    The insurer may deny your first request. But, usually you have more than one chance to get your case reviewed. You may appeal the decision “internally,” which means your benefits denial is reconsidered by reviewers for the insurer who were not involved in the initial decision. If your request is still denied after the internal appeals process, federal or state law may require the plan to allow you to start an “external” appeal, which means you send information about your benefits denial to an independent, outside group. Or, your insurer may waive the internal appeals process and let you go straight to an external appeal.


    This may also help: Balance Billing in Colorado described by a lawyer: http://www.adenverlawyer.com/2012/03...lance-billing/

    Last edited by bulldog; Mon Apr 10th, 2017 at 02:37 PM.
    Bulldog's Motto: F*ck around and I'm going to bite you!!!

  6. #78
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    Re: I had a pretty bad crash last summer... (video)

    this has nothing to do with Cheetos anymore. I'm out.



    Clovis let us know how far a lawyer gets ya. lol

  7. #79
    Gold Member bulldog's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Clovis, when did the insurance company pay your air ambulance bill? Any idea if the helicopter company every submitted an appeal on your behalf?

    Anyways, bad news is I checked the guidelines and most insurances give you 180 days to file a appeal. If one has not bee previously submitted it is probably too late.......




    Not sure you want my help as you have not replied, but I have 20 years in healthcare and I lead a team for the last 8 years that does medical recoveries, so I know the insurance business....yes I joke around on this board, but I'm actually pretty smart
    Last edited by bulldog; Tue Apr 11th, 2017 at 05:53 PM.
    Bulldog's Motto: F*ck around and I'm going to bite you!!!

  8. #80
    Senior Member j0ker's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by bulldog View Post
    Clovis, when did the insurance company pay your air ambulance bill? Any idea if the helicopter company every submitted an appeal on your behalf?

    Anyways, bad news is I checked the guidelines and most insurances give you 180 days to file a appeal. If one has not bee previously submitted it is probably too late.......

    P.S. Dang I reread your post and a $3000 deductible? Wow, mine is $350, so unfortunately sounds like your plan may not cover all that much and this is why you owe so much.


    Not sure you want my help as you have not replied, but I have 20 years in healthcare and I lead a team for the last 8 years that does medical recoveries, so I know the insurance business....yes I joke around on this board, but I'm actually pretty smart

    Oh well, was just trying to help, but seems way too late now................can't wait 9 months to fight a insurance companies payment (and yes this is the insurance company to blame and not the helicopter company because if they got paid what they expected (like you expected; in network for a emergency ride) they would not be coming after you).
    A friend of mine also works in insurance billing, only the part where you are way past collections and they work with you to remove some of the debit. From what she says, they can completely remove some charges for free. Even very large ones.

  9. #81
    Gold Member bulldog's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by j0ker View Post
    A friend of mine also works in insurance billing, only the part where you are way past collections and they work with you to remove some of the debit. From what she says, they can completely remove some charges for free. Even very large ones.
    True for all collectors....but it still ruins your credit for many years in most cases. Then depends if that company will accept that...some won't and air ambulance is not a doctor who make tons of money; those are multi-million dollar vehicles that also require some of the best and most expensive nurses and pilots. From what I have seen, they will negotiate, but writing it all off I have not seen before.....different than a doctor or hospital who sees multiple patients a day that can make up for the difference.....hence why air ambulance rides are so expensive.

    I felt I could have helped appeal this as I've worked on similar situations and been successful, but Clovis may be too late to fight the insurance company now, so those are his only options; try to sue or try to get it negotiated down more.
    Last edited by bulldog; Tue Apr 11th, 2017 at 05:54 PM.
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  10. #82
    Member texlurch's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Interesting side tid bit... wife works for the volunteer fire dept up here; if you live in the county services are free.. I think it even includes air transport... otherwise you get billed. Not sure if that is statewide or not.
    2000 Zx-12R; 2007 GSXR 600 (bosses bike)
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  11. #83
    Gold Member bulldog's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by texlurch View Post
    Interesting side tid bit... wife works for the volunteer fire dept up here; if you live in the county services are free.. I think it even includes air transport... otherwise you get billed. Not sure if that is statewide or not.
    Interesting. I've never seen free, but I've got many people covered by out-of-network when they lived in a remote area....even going to a different state (sometimes that is closer).

    Falls under this rule I posted before:
    • You live in a remote area where the network is not adequate to treat your serious condition.
    Bulldog's Motto: F*ck around and I'm going to bite you!!!

  12. #84
    Senior Member Aaron's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    So you call others stupid based on their career having never met them, and then you have to tell others how smart you are.

    Ya, you totally sound like a rocket scientist.

  13. #85
    Gold Member bulldog's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by Aaron View Post
    So you call others stupid based on their career having never met them, and then you have to tell others how smart you are.

    Ya, you totally sound like a rocket scientist.
    I called you a "idiot"...sheesh not even smart enough to get the word right. Not to mention what I posted really could have helped Clovis out.
    Last edited by bulldog; Tue Apr 11th, 2017 at 06:00 PM.
    Bulldog's Motto: F*ck around and I'm going to bite you!!!

  14. #86
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    Re: I had a pretty bad crash last summer... (video)

    so hostile!

  15. #87
    Senior Member j0ker's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by Aaron View Post
    So you call others stupid based on their career having never met them, and then you have to tell others how smart you are.

    Ya, you totally sound like a rocket scientist.
    I think he called you an idiot based on you not your job. Maybe I read it wrong.

  16. #88
    Senior Member The Black Knight's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by j0ker View Post
    I think he called you an idiot based on you not your job. Maybe I read it wrong.
    I blame the weed...
    ΜΟΛΩΝ ΛΑΒΕ

    "So live your life so the fear of death can never enter your heart. Trouble no one about their religion; respect others in their views, and demand that they respect yours. Love your life, perfect your life, beautify all things in your life. Seek to make your life long and of service to your people. Prepare a noble death song for the day when you go over the great divide.
    "

    "Finish today what others won't, so you can achieve tomorrow what others can't."




  17. #89
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    Re: I had a pretty bad crash last summer... (video)

    smoke weed everyday!

  18. #90
    Senior Member j0ker's Avatar
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    Re: I had a pretty bad crash last summer... (video)

    Quote Originally Posted by #1Townie View Post
    smoke weed everyday!
    Finally something we can agree on....

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