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Reader’s question:
What if I am refused approval for medical care I need immediately?
-A.O.
It’s something many of us are afraid of A.O.–I’m glad you asked.
If you have cancer, a tumor, or some other life-threatening condition that requires immediate care, you often don’t have the time to appeal with your family health insurance plan about providing you coverage. Instead, call the State Insurance Commission at 1-800-492-6116. The Commission will look over the facts of the case and decide whether your insurance company is right to deny to treatment. In cases where a doctor may refuse to treat you because you don’t have insurance, they will also review the case and see if your problem truly does present an emergency. If it is found that such care truly is an emergency, the Commision can order your family health insurance plan to provide coverage, or order to doctor to provide care. In cases of denials in emergency situations, the Commission must act within 24 hours. This is comforting to those who don’t want to get lost in an insurance company’s red tape.
If the problem is acute, such as puncturing a leg, getting hit by a car, or other life-threatening emergency conditions, do know that an emergency room cannot refuse to treat anyone, regardless of insurance. If you can’t get the matter resolved with your family health insurance plan, however, the hospital can then bill you directly.
Remember: Each plan has different rules for emergency room treatment. A cheap health insurance plan may save cost by requiring you to make “reasonable” attempts at treatment before going into the emergency room. Make sure you know exactly what they mean when they say “reasonable”
Nicholas
