WTF is insurance for if they can refuse to pay a claim?

I just got served papers today. I'm being sued in order to reconcile a medical debt from 2012.
I had severe cramping pain, that had me doubled over. I didn't know what it was from, I've never had such severe pain like that before...... So naturally, I panicked, and had a panic attack. Hyperventilated. Was shaking so bad, it scared a girl (all this happened while I was at work).
I asked the girl to call 911. I was terrified....she was too! Even told the ambulance that!
So... long story short, they tell me, "oh, you have ovarian cysts- it was just swelling....and you had a panic attack" "taking the ambulance wasn't medically necessary- you could have drove yourself to a quick care" "we are rejecting this claim".

Really?

So, I haven't paid- because I can't afford the $6000.....and I made 2 appeals, and NEVER heard back from anyone on the 2nd appeal.

All of a sudden I get served papers?

WTF is insurance for then???

Anyone have a similar experience? What did you do? What was the process going to a court?

Ok...I am trying to get this straight. You have insurance and they are saying that the ambulance was not necessary .....

Are you saying that the ambulance fee was 6,000 dollars?

Check again to see if the services were from 2012 or 2013. The Affordable Care Act changed lots of things starting in 2013. Could it be that the $6000 was your copayment and deductible for your health insurance?. That is based on the type of insurance that you have and has to be paid before your benefits kick in. Lots of employers have increased deductibles and company's and the Affordable Care Act deductibles and coinsurance levels are pretty high as I recall.

Yes, very expensive service- right?

Thank you for the information. At the time, my deductible was $500. The EOB I received flat out refused to cover, stating "not medically necessary". I don't know what to do. My plan is to reply to the summons, and tell them I had insurance, and don't understand why it was denied. It's only the truth. That's all I can do I guess.
This is very stressful.

There's no way an ambulance cost $6000.

That's the bill I got.

Do you know any lawyers that'd work cheap? They can't expect you to self-diagnose whether you need an ambulance.

You are probably stuck with the bill if you have appealed numerous times unfortunatly. You may want to consult an attorney, that's "usually" free.

If you do infact have to pay this, send 10.00 a month. that's a show of good faith in paying, I have included that I am unable to make a payment of more than X dollars, if they cash your check in "most all" cases they are agreeing to the payback. You do need to resolve this somehow as this bill is something that can allow them to garnish your wages.

Depending on the distance to ambulance has to travel its can be an enormous amount of money.

Sorry this has happened to you.

That's really lame. A free consult with a lawyer or even $500 on a lawyer may be well worth it. How are you supposed to know what was wrong??? Can your doctor help out at all with this?

That $6000 bill was not just for the ambulance. It would be about what you'ld expect to be charged for a combination of the ambulance, the E.R. visit, and the CT scan, or whatever type on imaging they did of your abdomen. (I went to the ER for belly pain a few years ago and that's what it cost me.)

Normally, you'ld be getting bills from separate parties. Usually, the ambulance is not operated by the hospital (though it might be.) So you'ld get a bill from whoever provides ambulance service, a bill from the hospital for use of the emergency room, and a bill from the radiologist who read the imaging done of your abdomen. The biggest part of the bill would be for the scan.

If you have limited financial resources, you might be eligible for reduced fees from the hospital. You might call their financial office to find out. The phone number for that would be on the bill that you get from the hospital.

You made a big mistake by self-diagnosing yourself as having a "panic attack." (even if you think you're sure that's what it was.) In the E.R. your job is to report your symptoms and let the docs there make what they will of them. The symptoms of a panic attack could also be the symptoms of a lot of things that are much more serious. Docs in the E.R. will usually list symptoms in whatever way makes them sound most worrisome, as a way of getting their money from the insurance company. Maybe, I'm wrong, but it sounded like you may have told the E.R. staff that you were having a panic attack. So they're going to be apt to agree with you.

Severe pain is a perfectly good reason to feel you are unable to drive yourself anywhere. You would have been smart to let the hyperventilating and shaking be interpreted as signs of severe pain, rather than signs of panic. That's basically what this whole dispute rests on: were you in too much pain to be able to transport yourself to get medical attention? At the E.R., they would have asked you to rate your pain on a 1 to 10 scale. Perhaps you gave them a modest number, and the insurance company can use that against you.

Getting served papers may not mean as much as you might think it means. Creditors sometimes do that as a scare tactic. I believe it's illegal for a creditor to threaten to sue, unless they actually plan to do so, but that threat is sometimes made without real intent to follow through. (It happened to me.) That paperwork you received from the court just means that the creditor may go to court to get the judge to say that this bill is legitimate, which the judge would likely agree with. (The services were rendered. Who has to pay for them is still up in the air.) That doesn't mean the judge will automatically say that the creditor can get your income garnished.

This bill is already over 2 years old. Check on-line to see what is the statute of limitations for debt in your state. I put a link below for you to do that. It might be only 3 years, depending where you live. (Can be 10 to 15 years, in some states.) You might be best served to simply default on the debt and let that amount of time run out. If you are young, have no significant assets, are living on a modest income, and are living in a state where the statute of limitations is short, then that might be the way to go. Just know that you have to not make any payments during the time interval of waiting out the statute of limitations. There will be phone calls pressuring you to do so.

As Christina says above, they can potentially go to court and get an order to garnish your bank account, or income. In that case, a judge will say how much can be taken. You have to be left with a certain minimum to survive on.

It's good that you submitted written appeals to the insurance company to reconsider their decision to not pay the claim. That they haven't responded is not surprising. You can sue them, I would think. However, their access to legal representation is probably about the best that there is, while yours is limited by you not being rich.

State Statutes Of Limitations For Old Debts | Bankrate.com

I just thought of something that puts this in a little clearer perspective.

The main reason for calling an ambulance is not to get transportation to a hospital. The main reason is supposed to be to get the emergency care of EMT's and/or paramedics. So just saying that you were in too much pain to drive is not a compelling reason, on its own, to need an ambulance. That's just a compelling reason to call a taxi. That's the argument the insurance company would make, and they would have a good point.

If you have any prior history of having been diagnosed with ovarian cysts, the insurance company would further argue that you could have known that the cysts may have been the cause of the pain and that these cysts acting up is not really a severe enough emergency needing hospital-based care.

If you did not have a prior history of this diagnosis, and even if you did, I would take it that they must have done a scan in the E.R. to be able to tell you that this was the problem. Those scans can cost thousands of dollars. That's what I would think is the main item making your cost be as high as it is.

Now that I think about it, you would be entitled to have that scan paid for by your insurance company in any case. Even if you had driven yourself to an urgent care center, the doctor there would probably have sent you for a scan. That's pretty much what it takes to identify the source of severe abdominal pain. So check exactly what is the breakdown in the costs you incurred on that day, and see what the insurance did and didn't pay for. I can't see how they can get away with not, at least, paying for the scan.

Thank you very much for the information. This is very helpful.

No advice to add here.

My husband suffered a massive heart attack [actually 2, died twice] in October and the VA has denied his claim because he "didn't call for preauthorization for treatment". :/ Seriously?

Just his flight was over 40 grand.

Sorry you are having to experience this. To the sane ppl [us], it makes absolutely no sense. Best wishes in your journey.

If I found myself in your position, I would call the insurance company, as it seems you did, and try to find out why exactly they are not paying. What specifically does their policy say, and how do they perceive that you do not qualify for their paying that expense? It sounds like the answer is that they found the ambulance ride to be "not medically necessary."

Next step, I suspect, would be to appeal their decision and submit documentation that it was, in fact, "medically necessary" and you could not "drive yourself" as they concluded.

If you have not done so already, call the insurance company and make sure you understand all of their deadlines and the proper procedure for this kind of an appeal. Insurance companies are out to make money and will screw you over if they can. Don't let them!

Sorry to hear about such a financially scary and frustrating situation.