My wife was having severe headaches and feared she had a serious medical problem. I took her in to the emergency room, they gave her a shot and a perscription and diagnosed it as sinusitis (sp). The insurance company is claiming the visit was unneccesary. To me, it seemed a necessay precaution. What can I do to get them to pay up?
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It's common practice to deny claims like this, especially when the ER billing came through with a diagnosis of sinusitus. But you need to appleal this.. in writing. Call the number (should be oon the back of your card) get the address, and lay out the facts... Your wife had been suffering with this for approx 8 - 9 days.. you both felt that it would pass.. on the 10th day she was in sever pain, after attempts to contact her family physician your only other option was the ER, as you had no idea what was wrong with her. After taking her to the ER, they were able to diagnose her. This was a situation that , in hindsight, we should not have tried to allow your wife's imune system to handle on her own. But you had no idea that it would worsen as rapidly as it did. Enclosed are the bills for service. According to the medical plan coverage does exist for these charges. Please review your decision to extend coverage. You may have to 2nd and 3rd request it.. Make sure you cc: the hospital, doctor, etc.. so they see that you have it under control. The company is a good one.. It's just common practice. However, if you were a doctor and could have figured out what was wrong with your wife.. you wouldn't need them. :)
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