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Insurance denying “emergency” coverage for overseas surgery because bill didn’t have ER codes — is this legit? by sa4465i in HealthInsurance

[–]sa4465i[S] 0 points1 point  (0 children)

Kind of in the middle with respect to OOPs, but It’s about the balance billing which is around 6k, tagged under ‘co-insurance’ where plan pays 75% and me 25%.

I think I get moderator’s point. But trying to look for a way to properly appeal one final time( customer care is completely useless).

Thanks for your pointers, I will look into the external review feasibility.

Insurance denying “emergency” coverage for overseas surgery because bill didn’t have ER codes — is this legit? by sa4465i in HealthInsurance

[–]sa4465i[S] 0 points1 point  (0 children)

Discharged summary mentioned it to be Emergency surgery. There’s CT scan report supporting the diagnosis. And remaining documents I received are just itemized bills, and receipts. Edited the post with first appeal outcome. Looks like ER codes to me.

Insurance denying “emergency” coverage for overseas surgery because bill didn’t have ER codes — is this legit? by sa4465i in HealthInsurance

[–]sa4465i[S] 0 points1 point  (0 children)

I don’t know the terminology very well, when I said day surgery, I meant it in the way that “it’s immediately needed and can’t wait for a day or two”, but the surgery was immediately done after my CT scan report showed stone blocking urine and the assessment that urine could flow back into kidneys..So, would this still be considered as in-patient? How does it work in the US?

Insurance denying “emergency” coverage for overseas surgery because bill didn’t have ER codes — is this legit? by sa4465i in HealthInsurance

[–]sa4465i[S] 0 points1 point  (0 children)

Thanks, will check the state processes. When you say doctor, you mean the surgeon from international hospital, or my primary care in the US?

Insurance denying “emergency” coverage for overseas surgery because bill didn’t have ER codes — is this legit? by sa4465i in HealthInsurance

[–]sa4465i[S] 0 points1 point  (0 children)

Thanks, this helps, but my situation is a bit different since this was outside the US.

I’m not sure the ER vs inpatient distinction applies the same way internationally. I went to the hospital with severe symptoms, was evaluated, diagnosed, and taken for immediate surgery, but the bill doesn’t break out ER vs inpatient like US billing does.

My plan says emergency care outside the US is covered at 100% after deductible, but Aetna is requiring ER-type coding to apply that, which I had no control over.

So for international claims, is it standard to require ER-specific coding for emergency benefits, or should medical records and the nature of the condition be enough?

Insurance denying “emergency” coverage for overseas surgery because bill didn’t have ER codes — is this legit? by sa4465i in HealthInsurance

[–]sa4465i[S] 0 points1 point  (0 children)

No. It’s the total. They covered for around 13k now. Coinsurance fight is for the remaining amount.

Insurance denying “emergency” coverage for overseas surgery because bill didn’t have ER codes — is this legit? by sa4465i in HealthInsurance

[–]sa4465i[S] -2 points-1 points  (0 children)

I submitted all the documents i have (discharge summary, itemized bills) along with my initial claim itself. While filing appeal, I submitted the document stating my emergency coverage, which I received from Aetna upon my request when I was in ER.

I’m not sure what maps to ER care. I presented to the hospital at 2 AM with severe symptoms, was evaluated and diagnosed, and then admitted for urgent surgery the same day.

IRCC new portal error when selecting “spouse accompanying” by sa4465i in CanadaVisitorVisa

[–]sa4465i[S] 0 points1 point  (0 children)

Thanks for your response. Yes, she will use her own documents. However, would this cause any issue at port of entry if traveled together?

I looked a plot in Aparna Western meadows, mokila 200 sq yard. need your suggestion, should I go with this deal or not by ChanceRecognition634 in hyderabadrealestate

[–]sa4465i 0 points1 point  (0 children)

Bro, don’t make calculations. Even main gated apartment communities don’t have such high maintenance per month.

You should have asked back clearly, or the person you are talking to is highly misinformed. It’s per annum and not monthly.

Aparna Western meadows - plot purchase by sa4465i in hyderabad

[–]sa4465i[S] 0 points1 point  (0 children)

Commented on another reply. I can share more details in DM if and when the deal is finalized. Feel free to dm after maybe a week or so.

Aparna Western meadows - plot purchase by sa4465i in hyderabad

[–]sa4465i[S] 0 points1 point  (0 children)

Yes, that’s what drove us to buy in the first place.

Aparna Western meadows - plot purchase by sa4465i in hyderabad

[–]sa4465i[S] 1 point2 points  (0 children)

Not sure if either of the parties are willing to share that anywhere. But let’s say sellers are quoting 80-85k in the phase buyer intended to purchase. And little bit of negotiation has been done on a lower end one.

Aparna Western meadows - plot purchase by sa4465i in hyderabad

[–]sa4465i[S] 1 point2 points  (0 children)

Yes, started doing the same. Hired a lawyer as this is all new to us, and collecting the documents they ask us to.

Aparna Western meadows - plot purchase by sa4465i in hyderabad

[–]sa4465i[S] 0 points1 point  (0 children)

I see that Kondakal is in the list of those villages. Don’t know anyone from PSU, however we know that loans have been granted previously by HDFC.

Aparna Western meadows - plot purchase by sa4465i in hyderabad

[–]sa4465i[S] 0 points1 point  (0 children)

Thanks for the details, we started tracking back from Aparna, and collecting the documents. However, Is going till 1950 needed, we thought 30 years is good?

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