WTF are they trying to say?

"Full of the sound of the Gran Fury, signifying nothing." (granfury)
12/02/2016 at 19:03 • Filed to: None

OK, I’m exhausted and recovering from a bout of food poisoning (I love Indian food, but it doesn’t seem to like me), so my comprehension level isn’t all that great right now and need someone to tell me if this bill is covered or not or only partially.

A couple of months ago I dragged my ass into the office against my better judgment since I was still on probation. My boss took one look at me and called 911 and had me hauled off to the hospital as I apparently looked like death warmed over (and I felt about the same, so looks weren’t deceiving). They took me over to the ER and I was diagnosed with a severe migraine; this is not the first time I’ve ended up in there because of this, but the last time was over a decade ago.

About a month ago I received some sort of notification regarding the ambulance/EMS services, something about having to pay nearly $300 of a $777 bill; had I known it was going to be so high I would have had someone drive me there instead. Today I received a multi-page document from the insurance company that I cannot interpret. The important line seems to be “ ... the original decision to process ambulance services at the In-Network benefit level not allowing 100% of billed charges on Septermber 08, 2016 is upheld”. That sentence alone is going to give me another migraine as it borders on the unintelligible. So, is any of my ambulance trip covered by my insurance? Is it all covered? Is none of it covered? What are they trying to tell me?

DISCUSSION (13)

CaptDale - is secretly British > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 19:06

What? That sentence is clearly lawyer speak for if we can trick him into paying this then we won’t cover it. Or at least that is my 2 cents.

ttyymmnn > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 19:08

Pretty sure it means that you owe $300. The entire bill was submitted to your insurer, and they chose to pay only a portion. That happens all the time with doctors. They submit a ghastly bill to the insurer, the insurer decided how much they will cover, and often, the doctor just eats the rest. But I don’t see the ambulance service eating the balance.

Full of the sound of the Gran Fury, signifying nothing. > ttyymmnn
12/02/2016 at 19:17

I also question how ambulance services can be determined to be In-Network or Out of Network. It’s not like I really had a choice as to who my ambulance provider was; I couldn’t really tell 911 to make sure to send a provider that was considered to be in network for my insurance plan, right? You would think that city services like this would be the expected first-line provider, but what do I know. I should have read the Explanation of Benefits before deciding to become deathly ill...

ttyymmnn > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 19:30

I don’t know all that much about ambulance bills vis a vis insurance. I was transported a few years ago for a major back spasm, and I know we got a bill despite our insurance. My guess is that no insurer covers ambulance costs 100%. But that’s only a guess. At least for peace of mind (if that’s possible), it would be worth a call to your insurer to have them explain how it all works. I’d be interested to know.

Wacko > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 20:25

Canada sounds good now doesn’t it. Free healthcare, and Trump free.

V8Demon - Prefers Autos for drag racing. Fite me! > Wacko
12/02/2016 at 20:44

How much of your income is taxed? Nothing’s free....

V8Demon - Prefers Autos for drag racing. Fite me! > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 20:45

Did you receive an explanation of benefits for the ambulance ride/hospital visit yet?

V8Demon - Prefers Autos for drag racing. Fite me! > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 20:48

The ambulance being in-network or out of network can be dependant upon a number of things to include your geographical location at the time of tsai incident with regard to your actual address. Since you were at work I’m gonna take a guess that you were relatively close to home. You policy may automatically place things over a certain distance from home out of network.......Bangladesh for an extreme example.....

Wacko > V8Demon - Prefers Autos for drag racing. Fite me!
12/02/2016 at 20:52

Between 30-40%. Sales tax is over 15%. And I believe we also get a bill for an ambulance. Gas is about 5$usd a gallon. And our cars rust to shit in no time.

All these taxes do pay for health care and school, college and university.

No system is perfect. But I like our system.

V8Demon - Prefers Autos for drag racing. Fite me! > Wacko
12/02/2016 at 21:02

The county I live in will bill for the ambulance ride. THe county I WORK in (which is right next door) doesn’t. Yet.

15% sales tax is absolutely ridiculous.

XJDano > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 21:05

I will say that I had a ambulance ride this year from STL city. Was $759.

Eric @ opposite-lock.com > Full of the sound of the Gran Fury, signifying nothing.
12/02/2016 at 21:05

Health insurance is wonky as wonky gets, IMHO.

Auto insurance? Simple/obvious.

Home insurance? Simple/obvious.

Health insurance? Complex back-and-forth. It’s almost as complicated as car accidents, but much of it is hidden from you in both cases. Basically: You get some kind of medical care, give them your insurance, they bill the insurance (which is complicated, trust me, I’ve worked for medical offices before), the insurance tells the doctor what they will pay (some negotiated rate, which varies by provider, type of service, or a bunch of other groupings that are way above my pay grade; sometimes this is a big cycle with many repetitions, which is why medical coder/biller is a very specialized skilled profession - these people engage in some serious dark sorcery) & what the negotiated billable is, then the insurance company makes a payment for the portion they cover (minus copay/deductible/etc), the billing/coding people process the payment, and ultimately they send you a bill for the difference.

It’s comically complicated. Usually the bill has the original “rack” price, the negotiated price, the amount the insurance paid, and what you need to pay. Since it’s a nice round number, I suspect it’s a copay that is set in your insurance policy.

Wacko > V8Demon - Prefers Autos for drag racing. Fite me!
12/02/2016 at 21:30

Welcome to Quebec, we are one of the most taxed places in the world.