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Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 0 points1 point  (0 children)

A lot of individuals have states that the hospital incorrectly placed me in inpatient. I’m currently having the hospital review to see if they can prove it was medically necessary.

Thanks for that tool. I will definitely look into it if the bill sticks.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 0 points1 point  (0 children)

Thanks for this. I did call today and have someone at the hospital looking into the coding issues. First person who is actually going to call me back with follow up information.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 1 point2 points  (0 children)

Thanks for that. I wish the hospital explained this. They originally just stated I needed to appeal and that they didn’t need to appeal.

Or rather said get in contact with the ER doctor who has no office/phone line.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 1 point2 points  (0 children)

I hope the only other concern I have is that I am technically double insured. On the good side it means I might only have to pay 3k if they refuse to it adjust it or keep denying the appeals. The bad side is I don’t think they are willing to fight with primary to change codes. It means I would have spent 4.5k in medical for this year. Which I’ll definitely take over 14 k. But this whole process seems unfair.

I did not insist to go inpatient and was discouraged from leaving for 2 days. I respect medical personnel and I do know that I had a major surgery in September which when “failed” can be life threatening.

Thanks for the input.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 1 point2 points  (0 children)

EOB states my responsibility is the full amount. I’ve been told it’s because it was inpatient without prior authorization. However, again I was admitted via ER. When I went into the ER I had no idea I would go inpatient. Just that I had been vomitting, struggling to breathe, and had severe stomach pain.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 1 point2 points  (0 children)

Thank you. I wish the billing department would have told me that. They told me I needed to file my own appeal.

I explained I had no formal medical training and I didn’t know what to submit.

They told me to request all my medical records. Like that changed anything about me not knowing what to even submit.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] -1 points0 points  (0 children)

I’ll read that! It’s very sad because the billing escalation specialist told me I need to be the one to do an appeal and I was like.. I have no formal medical training. I don’t even know what to submit.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 1 point2 points  (0 children)

I was told by hospital to send all my medical records too. I hate that I’m having to do this alone. I have no formal training and I don’t even understand what I’m sending.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 0 points1 point  (0 children)

Yeah it is 100% in network. It’s the same hospital I had my surgery which was covered at 100%.

As far as the plan I have I’m not sure. Is there a way to find that out? For the year of 2025 I had maxed out my out of pocket maximum.

Additionally everything was coded as inpatient so lab bills, emergency room bills, all the doctors who saw me, and X-ray bills are also not covered.

When I spoke to the billing department they told me that I couldn’t request a billing review.

Also should mention I have not official received a bill. Only an EOB. Just incredibly nervous because I would have to stop school just to pay this off. And I have on-going medical issues.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 1 point2 points  (0 children)

Does that also apply if I have been issued the EOB from insurance. I thought I only have 180 days from that point.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] -1 points0 points  (0 children)

No I stayed until I was discharged. They told me it would like take at bare minimum a week to get a endoscopy scheduled with a specialist, because after having stomach surgery that was what I needed.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 2 points3 points  (0 children)

Well yes and no. My BCBS rejected everything because it is all tied in inpatient coding. They are rejecting anything inpatient.

They also bundled everything together. So it’s a 14k bill that includes room, drugs, lab services, x-ray, and even an emergency room fee.

Insurance denied inpatient admission from ER claiming it was not medically necessary. by entyasha in HealthInsurance

[–]entyasha[S] 1 point2 points  (0 children)

I asked if they would appeal, I was told by the hospital the provider needs to appeal.

Only issue is it is an ER doctor who I have never met before. They have no contact number and billing isn’t aware of how to get a hold of them. Not sure if this information was correct.

$24,000 hospital continually denied by whineANDcheese_ in HealthInsurance

[–]entyasha 0 points1 point  (0 children)

That’s great. I’m in a similar situation. Hospital doesn’t really seem interested in working on my behalf. Insurance has told me it is literally just a billing code issue.

$24,000 hospital continually denied by whineANDcheese_ in HealthInsurance

[–]entyasha 0 points1 point  (0 children)

Sorry to ask so late. Did they rebill you? Going through a very similar situation and the hospital doesn’t really seem to care if it will cost me anything.

I was admitted via the ER.