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

[agnes!]

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

The OP posted a little bit further on that she didn't know at the time.

agnes!

 

[natenapril]

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).

Okay, dealing with Tricare right now myself. Be nice to them! And if that doesn't work have your Dh call Patient advocasy(sp?). Within 10 minutes of my Dh calling them they called me back ready to cut orders to get us to the closest specialist my DD needs to see. JUST BE NICE!!!

 

[scrapquitler]

In my town, ambulance/rescue/paramedics is run by the fire department. Once my daughter got hurt and needed to go to the ER, and I called 911. The ambulance came and brought her to the ER. We have Blue Cross...after all was said and done, Blue Cross didn't pay for the Ambulance ride to the hospital, they said it was not covered. I called the office manager of the paramedics department here in my town and spoke to them about it....after all, I'm paying taxes, the ambulance is run/owned by the town, why should I pay a few hundred $ for the ambulance ride? I explained to her and she said something to the effect of "Well we always bill your insurance, but if they don't pay it and you let us know that, we erase the charge and you won't be billed for it". In other words, if your insurance is willing to pay for it, they will be thrilled to take the money, otherwise, no charge.

So before you panic and or pay, give the ambulance company a call and talk to them...they might be willing to resubmit to your insurance with a different code which will get the insurance company to pay for it, or they may be willing to lower the charge or they may be willing to take payments or perhaps even erase the charges...you won't know unless you ask, and they are more likely to work with you if you are sweet and nice to them.

 

[jsmith]

I dont know which tri-care region you are in -but if you are normally seen in an MTF go to patient advocacy with all your paperwork and let them run interferance with Tri-care-thats what they are there for and you did exactly what we are told we need to do if we are seen outside the mtf. If you are on standard or prime remote i belive another poster said you can call patient advocacy-they will still help you out-there is no reason you should have to pay for the ambulance ride.

 

[bumbershoot]

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

Could also be what happened with our situation. The ambulance company billed insurance FIRST, before they got the info that there had been an emergent situation. So the system paid it as though it was an unnecessary ride.

Took close a year for some rep to FINALLY figure that one out!

And I never would have guessed; even though they billed insurance first, they were the last to send US a bill...

 

[portocall]

OP, I completely understand your frustration. Thankfully, both times a member of my family used an ambulance the insurance company decided to pay for it, however, I had no luck getting them to pay for fetal non-stress tests (done twice a week for 8 weeks) because they had nothing to do with a baby I told them the fetal part should have given them a clue, but still, no dice. I was too sick to fight at the time, however, I pay an arm and a leg for ours (over $500 per month, and that is only 25% of the policy) and I expect things to be paid for. Good Luck.

 

[LisaR]

We were in Hilton Head when DD got very ill. We took her to a walk in clinic and she lost consciousness. They called for an ambulance and she was taken to the ER. Thankfully she was fine a short while later.

Our insurance paid for everything except the ambulance ride. Their first excuse was that they didn't feel it was necessary. Yet, they felt it was necessary to have her treated in the ER and pay that bill?? Eventually they decided they weren't paying because we didn't go to our in-network hospital. Apparently the ambulance driver needed to take her from Hilton Head, SC to Michigan and they would have paid that bill.

We fought it and fought it. If I recall, it took 1.5 years of going back and forth before they got sick and tired of talking to me and they paid it.

 

[locolala]

Alright, thanks for all your advise

I called today and was very nice to the person on the phone (little did they know I was mentally stabbing Tricare with a spork), and they got it covered. Seems they need to know that the accident wasn't someone else's fault and that the facility I was at made me sign a waiver in case I was injured. Since I was on county property, the waiver isn't needed. The bill is being taken care of and I don't need to worry about a thing. What a headache though, this is the worst time of year to get medical bills!

 

[hereyago]

OP, glad you got it resolved.

My DM76 fell in June, broke her hip, had surgery went to rehab. In August, she came home fell again the same day, rehab had let her out with a flaming UTI, dehydrated and low potassium level-funny because they wanted her to stay over the weekend to observe her.

ANy how, she went to the ER stayed a few days in hospital. She went to another rehab, at first they were giving me a hard time saying TRicare wasn't being helpful. They let her stay-she also has Medicare-. Anyway, bills are starting to come to the house.

Tricare sends a application from the June incindent with a letter saying they weren't going to pay anything until it was filled out whether it was fall due to someone else or what. I called them and was like um this happened in June, why wait all this time to send a form and all the bills had to go back through.

I am now awaiting the other letter from the second fall, what it is now December, should be getting it any day. We get the EOB's and they are finally paying for the first round after Medicare.

 

[kaytieeldr]

(little did they know I was mentally stabbing Tricare with a spork),

Love it!!!! What better way to resolve all the issues - your/anyone's own frustration with the system, while not taking out one's anger on the representative on the phone (who, in all fairness, had no involvement with the original charge)!

Telephone representatives everywhere thank you!

 

[disneymarie]

I had an ER bill that was not being paid, the doctors portion. The room and treatment were paid. This went on forever battling over it,
FINALLY I got the gal from the health plan to look, she called the hospital and it was a coding issue.

The doctors bill code said I was treated at A SCHOOL:
It took over a year to find this out, no one would give the reason, they just said not covered....to pay it as it was going into collections...

I was so glad the ins provider went through the trouble to resolve it.

 

[bumbershoot]

The doctors bill code said I was treated at A SCHOOL:

OMG why is there even a code for that????

Seems they need to know that the accident wasn't someone else's fault and that the facility I was at made me sign a waiver in case I was injured.

What on earth does that have to do with covering an ambulance? They've all gone mad.....

 

[mjkacmom]

OP, I completely understand your frustration. Thankfully, both times a member of my family used an ambulance the insurance company decided to pay for it, however, I had no luck getting them to pay for fetal non-stress tests (done twice a week for 8 weeks) because they had nothing to do with a baby I told them the fetal part should have given them a clue, but still, no dice. I was too sick to fight at the time, however, I pay an arm and a leg for ours (over $500 per month, and that is only 25% of the policy) and I expect things to be paid for. Good Luck.

I spent over a year fighting a hospital stay for a failed induction, since I was discharged without having a baby. They said it wasn't pregnancy related. I went into labor the next day, so there was a 1 day gap in hospital stays. I had to get a NJ assemblyman to intervene.

OP, usually there is a co-pay with ambulance and ER's - could that be the charge?

 

[laurie31]

OMG why is there even a code for that????



What on earth does that have to do with covering an ambulance? They've all gone mad.....

If it was someone else's fault, then THEIR insurance is responsible. I had to fill out one of those forms when I fell. They *really* wanted it to be someone else's fault. Sorry insurance dudes, I slipped because the sidewalk was wet. Unless they put a glass dome over the city or something, I don't think anyone can stop the sidewalks from getting wet when it rains.


As for the school treatment, it is possible to get treated at a school (either a primary or secondary school with a clinic, or a college clinic). There is a code for EVERYTHING.

And yeah, I'm dealing with coding errors from my annual exam. It got coded as "high cholesterol" which I do not now nor have I ever had. It was just a check-up! They (insurance) insisted I must have been diagnosed with something, and therefore they wouldn't pay. Ummmm...so if I go for a check-up and everything is fine, they will pay, but if the doctor finds something wrong, they WON'T??? Isn't that the point of having check-ups? To find out early and get treatment before serious (and expensive) complications arise?

Insiuance is a big huge gnarly mess of tangled up knots!

OP - I'm glad you got your issue resolved so quickly!!