I told you back here that there was a happy resolution to Shelby's hospital saga back in June. Well . . . not quite.
One of the bills we'd received was a bill for $300 from the City of Anaheim for paramedic service. This bill was for the first-response EMTs that came after my 911 call, riding over on a fire truck from our local station. This was separate from our ambulance bill — the ambulance that came afterwards and took Shelby to the hospital is operated by a private company contracting with the city, and they'd already submitted their own bill.
As an opener, our insurance company completely refused payment. So I called and explained things. The woman I spoke with seemed to get it right away — apologizing, escalating the matter to her team leader — that was easy! The last words I spoke to her were:
"So then this should be reimbursed at 90% (the rate for emergency medical services) of $300, right?"
"That's right."
"Great! Thank you very much!"
Today I check the insurance company's website to find that they'd elected to pay $25.50 on the claim, leaving us to pay Anaheim the balance of $274.50. They'd decided that Anaheim had asked for far too much — the "prevailing charge" for the services we'd received was $51, and they then elected to reimburse that at 50% (the rate for non-emergency use of emergency services), arriving at a total of $25.50.
So I called again. This time I got a mealy-mouthed explanation about how they'd reimbursed at the 50% rate because "it wasn't an emergency". But how can finding my unconscious wife and making a 911 call that results in a multi-day hospitalization not be an emergency? "Well, the first ambulance that came had to call another ambulance, and they actually did the transportation — since they didn't take anyone anywhere, it wasn't an emergency." I suggested that the 'first ambulance' couldn't take anyone anywhere, because it was actually a fire truck — but she wasn't having any of that.
Well, what about the $51? Was I really supposed to believe that my city charged six times more than neighboring cities? "Yup, that's pretty much it!" Could they send me some documentation on how they arrived at the $51 figure? "We've got a database with all of the charges in it, and that's how we get the prevailing charge number for your area." Yes, but . . . after going back and forth on a few rounds of no-I'm-not-going-to-answer-your-question-but-will-provide-you-with-this-other-nongermane-information, I thanked her for her time and hung up.
A few hours after that, I got an E-mail message from the insurance company — I'd made in inquiry over the Web just before deciding to call — telling me that in light of the information I'd provided, they were adjusting my claim and paying at the 90% rate; my updated claim would be available on the website within 3-5 days. We'll see what we get this time, but I'm guessing it'll be 90% of $51.
Really, I guess that it's all my fault for being an uninformed consumer and not asking questions from my healthcare providers before committing to a course of action. Perhaps I should have bundled Shelby into the car and driven across Orange County, calling 911 in different cities and inquiring about their rates, before settling on my final choice for emergency services. Maybe I could've found an in-network fire truck provider!
Posted by Kevin at August 16, 2005 04:31 PM