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On a recent trip to Las Vegas, my wife was taken to a Nevada Hospital for chest pains. They admitted her for cardiac testing and 24 hr. observation. This done probably because she is currently being treated by a cardiologist here at home in Virginia for past issues involving her heart. The hospital determined no heart issues and discharged her about 26 hrs later. Our insurance company refuses to pay the $24,000.00 and advised me to begin the 3 tier level of appeal. 1. have the Nevada Dr. call them for a Peer to Peer review of my wife's condition and to change the paperwork from inpatient to outpatient status. (The admin.supervisor already told me that it is against the law to do so.) The Nevada Dr. has not responded and the insurance company advised me to continue appeal the insurance denial decision. This has not been going well and it looks like we are going to get stuck paying this amount. The insurance companies 3 tiers of appeals look like they will take months to get through. We will probably be served by a collection agency by then and I really don't want to deal with collection on any level. If it does go into collection, I searched similar situations on the internet and looked into our options. 1. Virginia will let the collection agency garnish her meager wages to 25% of disposable cash. 2. The collection agency can also put a lien on the house, which is in her name. 3. The collection agency can take money from our joint bank account. I'm getting ready for the storm and want to know how to batten down the hatches, so to speak. We can try to make a payment arrangement with the hospital, but we are on a fixed income and can't afford more than $30.00 per month. I know the hospital billing office will talk about arranging payment, but will probably not go for that amount. I think they will negotiate for a lesser amount, but will want that amount up front. There is a good chance they will simply turn it over to collection agency if they can't get a significant amount from us soon. Personally, I think the fault lies with the insurance company by denying a claim for emergency treatment and finding some technicality to get out of paying this bill. They have already asked us (not in writing of course) to have a medical doctor change hospital records from inpatient to outpatient. They have put us on a coarse to appeal which will probably not avoid the collection agency getting involved. When they looked at the medications my wife was on, they rightly put her on cardiac ward and under observation, which is reasonable under the circumstances. PLease advise me (including any law under the Obama Act) as to how to make the insurance company pay their bills and not try to wiggle out of this.
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We have been in touch with the hospital and are still waiting for their doctor to comply with our request for a peer to peer between him and Anthem staff doctor. We called hospital billing dept. and they are not billing yet. The appeal is still in tier 1 and moving forward. I don't expect Anthem will pay because their letter stated my wife's condition comes under MCG (TM) formerly Milliman Care Guideline (R) stating the hospital can watch her overnight for chest pain complaint, but cannot admit her to a full stay. This can only be done here at her home, or in her doctor's office. My wife is under cardiologist care taking prescribed metoprolol and atorvastatin. This is probably why the ER physicians treated her case as they did. They also said, without the test they had to give her, she should not fly back home to Virginia for risk of heart attack due to effect of airplane. I suppose I need to get a lawyer, but it comforts me to know that we can ask you questions up until that time. Thanks for being there. I will definitely be in touch with more questions as this thing proceeds.
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