If you are diverted to a non-network hospital in a medical emergency is it law that insurance has to cover?

Question

My wife was in active labor and we were diverted from our planned hospital of delivery to a non-network hospital. I called the insurance company, and was informed it was against the law for them not to cover the bill. The claim has been denied for the 4 time now for the full bill. I want to know if my insurance company has a legal obligation to pay the entire bill as that is what they told me initially.

Answer 1

I don't think so-at least not in my state (but it could be different where you are).

They might have been trying to tell you that it would have been against the law for the non-network hospital to refuse to provide treatment...that's the only other thing I can think of.

You might try calling the hospital where she had the baby and see if they can give you any information about if they have had this situation happen before-they would likely know the law about non-network insurance coverage as well.

Answer 2

My mom had a heart attack, and went to an in-network hospital. No problem, right? Except the physician who treated her in the ER was out of network. Her insurance company denied the claim 3 or 4 times before finally giving in and paying it. You might want to read that 3,000 page document they sent you when you enrolled - the member handbook. All insurance companies have different procedure they follow. But... if you were diverted out of medical necessity, and not by choice, then they will most likely end up having to pay the bill. Follow your insurance company's guidelines for filing an appeal, and if that doesn't work, each state has an agency for helping residents resolve insurance issues. They're called different things in different states, so try searching "insurance complaints" and your state.

Answer 3

You must follow the appeals process, as stated in your contract, they are a bureaucracy and hope that you give up, enlist the people who provide your coverage to speak to the insurance. Contact your local congressman's office and tell them what happened. You don't state the reason for being diverted, that's unusual in a maternity situation. Also file a complaint with the Insurance Commission of your state, it can usually be done on-line. Don't give up!

Answer 4

I'm confused as to what you are asking. My insurance would pay part of the bill for ANY hospital in any case. It would not pay the ENTIRE bill for a network hospital unless I had already paid the annual out of pocket maximum. Are you sure your not just being asked to pay your share of the bill?

Answer 5

greater often than no longer regulations do no longer conceal out of community expenditures (or in the event that they do, no longer @ the comparable point) as in community expenditures apart from existence-threatening emergencies. i'm no longer a scientific provider yet experience an appendectomy could qualify. thankfully on recent regulations the load of evidence has shifted from a scientific expert pondering it as a existence-threatening difficulty to that of being a prudent layperson pondering it to be a existence-threatenting difficulty. it extremely is extremely helpful to learn your boyfriend's coverage for good info and prefer the others mentioned, have the healthcare expert or wellbeing middle write a letter to the coverage employer documenting his difficulty @ the time, asking for that his denial be reconsidered. solid success!