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AmeriBen/IEC won't pay my ER bill
I was covered by AmeriBen through my school as a student. The health procedure they have at the school is that unless it's a true emergency, they prefer you to come to the student health clinic on campus.
I did just that and I was told by an MD that I needed to go to the ER immediately, therefore I did as per his medical advise.
Two months later, I got a letter from AmeriBen totally denying the claim with code EMR.
"EMR = Emergency Room Visit for non-emergency care is a specific exclusion of the plan. "
Who do I call and gripe? The hospital to bill it again as emergency... or the insurance company ?
I did just that and I was told by an MD that I needed to go to the ER immediately, therefore I did as per his medical advise.
Two months later, I got a letter from AmeriBen totally denying the claim with code EMR.
"EMR = Emergency Room Visit for non-emergency care is a specific exclusion of the plan. "
Who do I call and gripe? The hospital to bill it again as emergency... or the insurance company ?
MEDICAL PROFESSIONAL
Dear slim20,
It sounds like you are dealing with a situation that was resulted from a difference of opinion between your Campus doctor who believed you needed emergency care & advised you to go to the ER and the ER doctor who didn’t agree & coded your visit "Emergency Room Visit for non-emergency care".
You need to ask the campus clinic for copy of the record for this particular visit & hope that the doctor who advised you to go to ER documented this fact. If you can provide your insurance company with this evidence, they are likely to cover your ER visit regardless of how it is coded!
Sincerely,
Amir Mostafaie
It sounds like you are dealing with a situation that was resulted from a difference of opinion between your Campus doctor who believed you needed emergency care & advised you to go to the ER and the ER doctor who didn’t agree & coded your visit "Emergency Room Visit for non-emergency care".
You need to ask the campus clinic for copy of the record for this particular visit & hope that the doctor who advised you to go to ER documented this fact. If you can provide your insurance company with this evidence, they are likely to cover your ER visit regardless of how it is coded!
Sincerely,
Amir Mostafaie
Yeah, I had them fax over everything. They rejected the claim again, claiming that I waited many days after being advised to go to the ER.
I went the same day. I don't know where they got that non-sense, but they were nonetheless fast to give the "claim denied" stamp and they some how did not realize looking at the "date of service" on documents would clarify issue and I had to tell them to do so.
It's almost like they're looking for every cause they can to give the "claim denied", so if "clerical error" resulted in denied claim, you have to fight it... like I am.. and if clerical error results in "overpayment" then you're obliged to pay 'em back...
I'm so tired of going back and forth.
I'm not sure if this is what's expected from a typical US based insurance company, but I'm certainly getting tired of dealing with Ameriben/IEC Group. The school dumped them in favor of Aetna and I've not used it yet, but I hope it isn't this bad.
I went the same day. I don't know where they got that non-sense, but they were nonetheless fast to give the "claim denied" stamp and they some how did not realize looking at the "date of service" on documents would clarify issue and I had to tell them to do so.
It's almost like they're looking for every cause they can to give the "claim denied", so if "clerical error" resulted in denied claim, you have to fight it... like I am.. and if clerical error results in "overpayment" then you're obliged to pay 'em back...
I'm so tired of going back and forth.
I'm not sure if this is what's expected from a typical US based insurance company, but I'm certainly getting tired of dealing with Ameriben/IEC Group. The school dumped them in favor of Aetna and I've not used it yet, but I hope it isn't this bad.
MEDICAL PROFESSIONAL
Dear slim20,
I am sorry to hear that. Were you able to get your records for your on-campus visit, during which you were advised to go to the ER?
Amir Mostafaie
I am sorry to hear that. Were you able to get your records for your on-campus visit, during which you were advised to go to the ER?
Amir Mostafaie
They're giving me a bunch of BS and denied my claim.
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