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Start with HR
Then insurance. Usually, it's some procedural missing piece of verification.
Some insurances will cover only in network ERs and out of network requires prior auth. What they will but, someone at ER should have called and done that, if that's the case.
I remember when we were assigned to the UW Hospital here, and I went to Valley Medical, as son broke both wrists and they were 20 min away, while UW was an hour drive. Not only they held him without pain medication for 8 hrs, as it required PCP consent for the 2nd shot but, also, we ended with $16K bill from them. Didn't pay it but took few months of the nervous fight with them.
Got to be careful with that stuff.
Most employers have an employee handbook that covers things like policies, time off, and may have information about your health coverage.
For information about why that specific claim was denied I would start by calling your health insurance and asking. The answer might be completely different from what you are assuming.
Most employers have an employee handbook that covers things like policies, time off, and may have information about your health coverage.
For information about why that specific claim was denied I would start by calling your health insurance and asking. The answer might be completely different from what you are assuming.
You should have received an EOB - explanation of benefits statement - which will state the reason for denial. When I worked, my employer's health insurance was paid through the first Friday of the month - but that was in 2009 and specific to that employer. These days I have read of health insurance terminating with the employment - but you weren't effectively off their payroll until the day following your wife's ER admission.
Also, coverage can be denied for ER if there was not a compelling reason for the visit. This is very subjective and a relatively new wrinkle used by some plans to cut costs.
Ditto on Ariadne questions. What does the EOB give for the denial?
As for your employment status, if covered under COBRA, she can control her insurance termination date. Although your employment may have ended, if the employment is covered under COBRA, she has the right to elect continued converge without any gaps.
Now, the missing piece is the nature of her ER visit. If it wasn't a legitimate ER visit applying reasonable contemporary need base standards, insurance companies usually have the right to deny.
Also, coverage can be denied for ER if there was not a compelling reason for the visit. This is very subjective and a relatively new wrinkle used by some plans to cut costs.
This is what I wondered about, too. It may have nothing to do with OP's employment status, and everything to do with the ER visit itself. OP needs to call his insurance and get more information to determine why the claim was denied.
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