I'm going to blow up at someone tomorrow..

[locolala]

So, back in October I fell off the horse I ride, and ended up needing an ambulance trip to the ER. I fractured the top of my femur and had to use crutches up until about 2 weeks ago.

Today I got a bill in the mail from the ambulance company, and a letter from Tricare (military health insurance). Apparently Tricare isn't wanting to pay for the ambulance trip to the ER. They didn't feel it was necessary. I guess I was supposed to hobble to the car and drive to the ER? I couldn't even straighten my leg, I almost blacked out from the pain, and I threw up from the pain twice before the ambulance even got there. They're willing to pay the 1500 dollar ER bill, but not 150 for the ambulance. Absolutely ridiculous in my opinion. The paramedics couldn't even roll me on my back because they wanted to keep my leg stable, they had to use a scoop to pick me up and put me on the stretcher.

I'm totally calling Tricare tomorrow and reaming them a new one. Hell hath no fury like an angry pregnant woman.

And yes, we can afford the 150 bucks.. money might be a little tight afterwards but it's the principle of the matter. What's the point in having total health coverage if they don't cover stuff? I pay NOTHING to have this insurance, I just have to put up with military doctors!

 

[Disneyland1084]

That's so crappy! I hope you can get it straightened out tomorrow. This made me think of a very frustrating thing I dealt with earlier today with my doctor. I'm expecting another baby in 7 weeks and my employer had me fax some forms my Obgyn needed to fill out. The nurse calls me today and says they're completed, but that there's a $20 fee, and that it had to be paid before they fax it to my employer. **** that!!! I was polite to the nurse, but am going to talk to my doctor about it when I see her on Monday. That was so ****ty. I've already prepaid $1,500 for my delivery and I'm being charged a fee for her to fill out PAPERWORK???? Whatever!!!

 

[Mysteria]

Were you pregnant when you fell off the horse?

 

[samshane]

We have Tricare as well... good luck! I had some issues and went in all angry and mad - like I was going to have someone's job. Dh called and sweet and nice and he got everything straightened out. (we moved remote to a base and I was 7 months pregnant and tryin to find a new OB).

He always says you can get more flies with sugar or some BS thing like that... LOL! but I have to say it worked (and I don't ever like to admit he is right).

 

[locolala]

Were you pregnant when you fell off the horse?

Technically yes, but we didn't find out until the next weekend. They ran a test at the hospital and it was negative, so it was still really early.

 

[a1tinkfans]

Go in with SWEETNESS rather than Anger, you'll likely get further with them.
I think they made a mistake and to get them to "eat that" is not an easy task....
Good Luck....I would explain the situation and state exactly what you said here, you were UNABLE to ambulate safely and was vomiting and certainly could not drive....
I think they'll reconsider but MAY have you file a formal "review".

 

[dejr_8]

Someone probably entered the incorrect medical code for your broken leg making it look like an ambulance ride wasn't necessary.

For the first call I would be sweet and don't get mad at the first person you speak with. They could be a Work At Home Mom and just the first layer. If they can't do anything ask to speak with a supervisor.

 

[golfgal]

Someone probably entered the incorrect medical code for your broken leg making it look like an ambulance ride wasn't necessary.

For the first call I would be sweet and don't get mad at the first person you speak with. They could be a Work At Home Mom and just the first layer. If they can't do anything ask to speak with a supervisor.

That is what I was going to say 99 out of 100 times it is a simple coding error and easily fixed.

 

[Kies99]

My brother works for a healthcare company. He's told me lots of "trade secrets" if you will.

As other's have said, definitely do not go into the call angry and definitely ask to speak with a supervisor.

Some times these companies turn down claims hoping they won't be challenged and therefore can cut some costs. They may rely on the individual just blowing off the charge and paying out of pocket.

 

[mjkacmom]

Well, if it makes you feel any better, I have aetna, and my co-pay for an ambulance ride is $350!

 

[3doodlebugsmom]

I have a question for you. Was it an ambulance or a rescue that picked you up? It could make a difference. We have United Heralthcare. Rescue runs are covered, but ambulance runs have a 20% co-pay. We found this out the hard way when my DH had a seizure at work. The place where he works is quite large and they have their own rescue equipment on site, except it is an "ambulance". We paid 170.00.

 

[laurie31]

Good luck!

I fell in June and shattered my wrist. I was in so much pain I could hardly breathe (and I had natural childbirth, so I know what pain is - lol) and I couldn't move. I thought it prudent to have a witness call an ambulance rather than try to move me into their car and drive me. However, my insurance (Blue Cross/Blue Shield) said it wasn't medically necessary, and to make things worse, the ambulance company that responded wasn't "in network" so I am responsible for the ENTIRE charge of $715 and not just the "allowable" charge of $630.

I can't FATHOM what the $715 is for. They drove me 14 miles to the hospital. No oxygen, no drugs, no nothing. I was begging for pain meds, but they felt that my breathing was so bad that they were scared to give them to me. Okay, I know pain medication can suppress your breathing, and that's a Very Bad Thing, but the reason I couldn't breathe is because I was in so much pain. I nearly passed out from it.

I have fought, pled, begged, been nice, been through my HR dept at work, and nothing has helped. I couldn't even get the ambulance company to write off the "extra" $75 that doesn't count against my deductible since it's not an "allowable charge."

Also, I asked my insurance what ambulance services ARE "in network" so in case there's a next time, I will use the correct one. The person reluctantly admitted that there are NO ambulance services in their network as they are too expensive, and if there's a next time, I should get someone to drive me to the hospital, that people just shouldn't use ambulances. That's just great. What if someone's having a heart attack and they arrest in the car? You can't do CPR and drive!

So OP, I feel your pain. Literally. If you get anywhere with Tricare, please come back and update (and share your strategy! LOL!)

 

[manning]

We have Tricare as well... good luck! I had some issues and went in all angry and mad - like I was going to have someone's job. Dh called and sweet and nice and he got everything straightened out. (we moved remote to a base and I was 7 months pregnant and tryin to find a new OB).

He always says you can get more flies with sugar or some BS thing like that... LOL! but I have to say it worked (and I don't ever like to admit he is right).

You can catch more flies with honey than with vinegar.

 

[Nik's Mom]

So, back in October I fell off the horse I ride, and ended up needing an ambulance trip to the ER. I fractured the top of my femur and had to use crutches up until about 2 weeks ago.

Today I got a bill in the mail from the ambulance company, and a letter from Tricare (military health insurance). Apparently Tricare isn't wanting to pay for the ambulance trip to the ER. They didn't feel it was necessary. I guess I was supposed to hobble to the car and drive to the ER? I couldn't even straighten my leg, I almost blacked out from the pain, and I threw up from the pain twice before the ambulance even got there. They're willing to pay the 1500 dollar ER bill, but not 150 for the ambulance. Absolutely ridiculous in my opinion. The paramedics couldn't even roll me on my back because they wanted to keep my leg stable, they had to use a scoop to pick me up and put me on the stretcher.

I'm totally calling Tricare tomorrow and reaming them a new one. Hell hath no fury like an angry pregnant woman.

And yes, we can afford the 150 bucks.. money might be a little tight afterwards but it's the principle of the matter. What's the point in having total health coverage if they don't cover stuff? I pay NOTHING to have this insurance, I just have to put up with military doctors!

First off, glad you are ok now. I'm sorry about that bill. That stinks. I don't blame you for being angry. I got an outrageous bill for $600 when I had a mamogram a few months back. I had a lump and my doctor wanted to make sure it wasn't cancer. Thank God it wasn't. But then I get that bill. I called my insurance to see what was going on and they said they wouldn't cover it because it was a diagnostic mamogram. They only cover mamograms as part of a well woman exam. How stupid is that?

 

[Lisa loves Pooh]

Go for it. You might even see if the hospital can in anyway provide support on the need for the ride. Just try to do it kindly. Often in customer service--if a customer is just over the top belligerant, we have no incentive to help them. But if they state their case kindly, it's entirely different.

*****

One time--my mom suffered a 3rd degree burn when a debris pile we were burning somehow had a piece of plastic land in it and then it floated out and wrapped around her leg. The burn area was small as a % of her body--but it was a very serious 3rd degree burn. She was active duty and reported on base as she was to do for any non-emergent medical need. She was not in uniform as her uniform required panty hose if she wore a skirt and she could not put on pants. Well, they refused to treat her for showing up out of uniform.

She went to an urgent care clinic--which in the end was probably a good thing as they took excellent care of her burn and from a distance, you cannot see any scarring. (Up close, you can see the mild purple discoloration).

The military refused to pay her medical bills. She fought it and one and they covered everything.

This was back in the days when us dependants were on Champus.

****

One time, I had a PPO that did not cover UTI's treated in ER. I had something very wrong and was devestated to learn it was a UTI as I was a college student working FT who didn't have the extra cash. It was early in the morning, nothing was open and I had lost my ability to go on my own and pressure was mounting. Waiting for a clinic to open was a no go. I have no idea what Shands did, but I didn't have one problem with my insurance at all. All staff that helped me said that I did the right thing. So whatever magic they did was most appreciated (if they did anything at all). But I was very freaked out that I would be stuck with a very high ER bill all b/c I had to go potty and was not able to.

 

[mickeyboat]

I wonder if there is an ambulance co-pay.

I googled tricare ambulance coverage and it said it does not cover transportation that could have been provided otherwise - ie by taxi. I can't imagine they would want someone with a severely broken leg and who is passing out riding in a taxi to the emergency room. I bet the care was coded incorrectly, and a kind phone call will solve your problem.

Good luck!

 

[Jennasis]

So, back in October I fell off the horse I ride, and ended up needing an ambulance trip to the ER. I fractured the top of my femur and had to use crutches up until about 2 weeks ago.

Today I got a bill in the mail from the ambulance company, and a letter from Tricare (military health insurance). Apparently Tricare isn't wanting to pay for the ambulance trip to the ER. They didn't feel it was necessary. I guess I was supposed to hobble to the car and drive to the ER? I couldn't even straighten my leg, I almost blacked out from the pain, and I threw up from the pain twice before the ambulance even got there. They're willing to pay the 1500 dollar ER bill, but not 150 for the ambulance. Absolutely ridiculous in my opinion. The paramedics couldn't even roll me on my back because they wanted to keep my leg stable, they had to use a scoop to pick me up and put me on the stretcher.

I'm totally calling Tricare tomorrow and reaming them a new one. Hell hath no fury like an angry pregnant woman.

And yes, we can afford the 150 bucks.. money might be a little tight afterwards but it's the principle of the matter. What's the point in having total health coverage if they don't cover stuff? I pay NOTHING to have this insurance, I just have to put up with military doctors!

But were you wearing a helmet? Sorry, couldn't resist!

That stinks! I'm sure you'll get it straightened out one way or the other. Be persistant (but pleasant).

Hope you get "back on the horse" after the baby comes, and glad your doing better now!

 

[Planogirl]

Your ambulance was only $150? When DH had his minor heart attack, the ambulance that took him to the hospital charged over $500 and the insurance paid a whopping $50. DH said that the staff in the ambulance just monitored him so that was pricey!

I hope that you get some money out of these people. Geesh, they get wacky.

 

[Maddle]

Be sure to ask for appeal information.

It is absurd to think that you would be expected to use anything other than an ambulance/rescue squad.

Maddle

 

[wdwfan16]

So, back in October I fell off the horse I ride, and ended up needing an ambulance trip to the ER. I fractured the top of my femur and had to use crutches up until about 2 weeks ago.

Today I got a bill in the mail from the ambulance company, and a letter from Tricare (military health insurance). Apparently Tricare isn't wanting to pay for the ambulance trip to the ER. They didn't feel it was necessary. I guess I was supposed to hobble to the car and drive to the ER? I couldn't even straighten my leg, I almost blacked out from the pain, and I threw up from the pain twice before the ambulance even got there. They're willing to pay the 1500 dollar ER bill, but not 150 for the ambulance. Absolutely ridiculous in my opinion. The paramedics couldn't even roll me on my back because they wanted to keep my leg stable, they had to use a scoop to pick me up and put me on the stretcher.

I'm totally calling Tricare tomorrow and reaming them a new one. Hell hath no fury like an angry pregnant woman.

And yes, we can afford the 150 bucks.. money might be a little tight afterwards but it's the principle of the matter. What's the point in having total health coverage if they don't cover stuff? I pay NOTHING to have this insurance, I just have to put up with military doctors!

You were riding horses and took a tumble while you were pregnant!!!!