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

[Clovis]

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.

[bulldog]

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!

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!