[franz kafka]

I had an emergency room visit denied because the diagnosis of schizoaffective disorder doesn't count as an emergency. It's a "minor illness." What the hell?! Now I have to dig up medical records that say I was suicidal and being held at the psych ER against my will/on a legal hold.

It was probably a coding issue. Call the hospital and talk to the person who files bills against insurance. Probably if they change the coding to reflect suicidality, it will be considered emergent and will be covered. Almost all insurance denials result from coding issues, and they count on people not to question it. The hospital wants to be paid, so if they can fix the coding to get insurance to cover it, they will absolutely want to do so.

[franz kafka]

Thanks lola, I'll look into that!

[raspberrytorte]

They said it was a minor illness? What the hell. I'm sorry this is happening to you!

What they probably meant was that it wasn't a diagnosis that warranted ER treatment; in other words, it should be handled outpatient. However, if the diagnosis reflects suicidality somehow (not sure how they code this but they know how), it will likely be covered. The insurance company is playing a game here in order not to pay out. Hospital should know how to code it so they will be paid. Somebody screwed up on the hospital end and insurance is taking advantage of it. Always, always, always question medical bills if insurance doesn't seem to be paying properly. They deliberately play dumb and go ONLY by whatever coding is in front of them (they don't have detailed hospital records).