Here's the situation:

1) Girlfriend has documented history of asthma.
2) Girlfriend gets Assurant Short-Term Health.
-It covers emergency visits
-It does not cover mental illness expenses (important point)
3) Girlfriend is working and suffers an intense asthma attack; she starts coughing, trouble breathing, uses her inhaler, doesn't help, uses it again, nothing, can't breathe, the works
4) Boyfriend (me) heroically zooms to the his damsel in distress and takes her to Rex Hospital Emergency room
5) Girlfriend is seen by nurse, who decides that girlfriend is suffering from hyperventilation brought on by anxiety
-Girlfriend has documented history of asthma
-Girlfriend was suffering no anxiety, and was happy about her last day at work
-Nurse describes a symptom of hyperventilation is blue lips, as you are not getting enough carbon dioxide, and puts a rebreather mask on girlfriend.
-Girlfriend did not have blue lips
6) Nurse treats girlfriend for hyperventilation by talking to her soothingly...which doesn't help at all.
7) After 2 or more hours in the ER (from time of check in), asthma attack decreases in severity and girlfriend wants to just go home, so she accepts to be checked out of the ER while still wheezing
8) Boyfriend heroically tries to stand for her patient rights to correct medical treatment but is struck down by a diabolical combination of pout face and puppy eyes

Now, this is what I'm assuming happened:
9) Nurse files this under 'hyperventilation', which is classified as a "Mental Illness" by the International Classification of Diseases" database.
10) Hospital files claim to girlfriend's insurance
11) Insurance sees "Mental Illness" and says they can not cover it (which is legit)
12) Hospital gives girlfriend the bill, plus another bill from Raleigh Emergency Medical Association

I called the insurance company (I have a policy with them too) and we talk, and the guy says I need to call the hospital and get them to correct the diagnosis before the insurance can cover it.

Is there any luck that we can argue that girlfriend had an asthma attack instead of the incorrect hyperventilation and get them to submit a changed diagnosis?

Also, girlfriend's mom is an ER nurse outside of Raleigh and agreed that, based on the symptoms and patient history, it was definitely an asthma attack.

Edit: HAH I think I have it.

Hyperventilation has two forms in the ICB:
1) Mental and behavioural disorders -> Neurotic, stress-related and somatoform disorders -> F45.3 Somatoform autonomic dysfunction -> Psychogenic forms of: hyperventilation
2) "Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified " -> "Symptoms and signs involving the circulatory and respiratory systems " -> R06.4 Hyperventilation

I literally asked the nurse why she was "hyperventilating" if she was not stressed and she said it could a vicious cycle brought on by the coughing fit. Hence the low CO2 levels (and no blue lips...but w/e roll with it).

So basically I get the hospital to correct the diagnosis from a mental illness to an abnormal clinical finding of hyperventilation and we should be set, right?

[Edited on December 15, 2010 at 7:23 PM. Reason : lkj]

[Edited on December 15, 2010 at 7:23 PM. Reason : lkj]

12/15/2010 7:10:07 PM

I'm not sure about your specific question, but if worse comes to worse the hospital will work with you. I had to get surgery before my insurance started and the hospital worked with me to reduce the bill and put me on a no-interest payment plan.

12/15/2010 7:21:55 PM

call the hospital billing department. I'm sure they can help you.

12/15/2010 7:29:54 PM

Yeah, I'll have to do it between 8 and 5 though.

Any experiences getting a diagnosis changed? I'm just worried the department will be all "nope, she got treatment and signed it, not changing it"

12/15/2010 7:32:18 PM

nah, they're usually pretty flexible if you just ask

this is a pretty obvious case to me, especially given the hx of asthma

but R06.4 is an ICD10 code which won't be used until 2013 the ICD9 equivalent is 786.01.

[Edited on December 15, 2010 at 7:40 PM. Reason : 306.1 is psychogenic hyperventilation]

12/15/2010 7:37:53 PM

hospital billing department is willing to do anything to get paid. If you just tell them that you can't pay the bill and if they change the diagnosis code, the insurance will pay it, I'm sure they'll do it in a heart beat.

12/15/2010 7:51:11 PM

Oh look, I found your problem.

Quote :

"Boyfriend heroically tries to stand for her patient rights to correct medical treatment but is struck down by a diabolical combination of pout face and puppy eyes"

Be a man next time and get it fixed before you walk out the door. Caveat Emptor

12/15/2010 8:31:23 PM

^ Trying to be tuff, ITT

12/15/2010 8:36:52 PM

So tuff

12/15/2010 8:55:03 PM

^^^ meh, it wasn't his decision. I was going home, with or without him.

and thanks for the help to the other people itt

12/15/2010 11:10:03 PM

was she actually seen by a physician?


Nurses do not diagnose....it is not in their scope of practice.

if she signed out before being seen by a doctor........dont know what they can do to change the dx.
im sure there are some loopholes maybe.

12/16/2010 9:28:46 AM

Here's the deal...having been in and out of hospitals for the better part of the last year and a half, my wife and I had to be prepared for visits like this.

If she has documented history of asthma, bring documentation. Inhaler itself and your word won't cut it.

Does she not have a primary doctor in the area? If not, get one. Or get documentation necessary from doctor that prescribed the inhaler.

If you were never seen by a doctor, that's a problem...and it helps to talk to the doctor and not just nod with what he or she says. Keep them in there until you're sure he understands the situation. Shit goes smoother when that happens.

And like everyone else said, call the billing department. All they want to do is get paid.

We called somewhere and said, "Hey, we can't pay this much." They lopped 20% off the bill sight unseen.

[Edited on December 16, 2010 at 10:22 AM. Reason : ]

12/16/2010 10:22:11 AM

Quote :

"was she actually seen by a physician? Nurses do not diagnose....it is not in their scope of practice."

Nope, just a nurse. bmel's mom is an ER nurse and said that our nurse was likely under the authority of a doctor or some shit.

Guess I'll try and have her get records of asthma/prescription for the inhaler.

I did argue with the nurse about the wrong diagnosis, but she was being stubborn, and then bmel did not want to stay and see a doctor so I didn't really have any choice.

I'll call and see what happens.

Well I called billing and they said they can't do anything about it, so I need to call the physicians and get a doc on the line.

[Edited on December 16, 2010 at 11:45 AM. Reason : lkj]

12/16/2010 11:24:58 AM

If you're on crappy insurance then you need to stick around until you get the paperwork you need that will get your bill covered by insurance. I know it sucks sitting around the hospital but in the future you know to stick around until a doctor shows up. From what my friend that works in a Greensboro hospital tells me of nurses, I wouldn't want them touching me until a doctor showed up anyway

It sucks that you're probably going to end up eating the costs on this Let us know what ends up happening!

12/16/2010 12:52:53 PM

Well now I'm getting the run around. After Rex told me to call the Emergency Med people directly, I called the number they provided and got routed to a call center up in Pennsylvania. That location could not deal with the code change, and told me I need to call Rex to get the physician numbers. I call Rex again and they said I need to call the call center, or call the hospital main line to try and get the physicians directly.

>_>

I googled Raleigh Emergency Medicine and got their direct line, which was manned by an answering machine that told me to call the billing call center or the Rex billing department. I left a message.

12/16/2010 2:44:41 PM

For some reason, I'm not surprised that the ER docs don't want to deal with this billing crap.

12/16/2010 3:05:00 PM

How much was the bill?

12/16/2010 3:13:40 PM

^

[Edited on December 16, 2010 at 3:26 PM. Reason : Also, no offense, but it's bmel's insurance and medical care. So, why isn't she dealing with it?]

[Edited on December 16, 2010 at 3:27 PM. Reason : V Skwinkle has dealt with this before. ]

12/16/2010 3:25:15 PM

every damn hospital bill is a difficult bill, in my experience. at least from Duke anyway

I've had my shit sent to collection agencies because "my address wasn't on file" when I haven't moved in like 10 years and I go for a visit like twice a year at the minimum. And then you can never get a hold of anybody that knows anything about it.



I know that doesn't help you in the slightest but just know that even if you get it right now, you may eventually have to fuck around with it again. My mom (before I was on my own insurance) got a bill for something she already paid a year prior. So make sure you keep everything for a while, even if its paid

[Edited on December 16, 2010 at 3:34 PM. Reason : .]

12/16/2010 3:26:15 PM

I didn't read the thread but

Quote :

"It does not cover mental illness expenses"

Attractive, single, and mentally stable. Pick two.

12/16/2010 3:38:00 PM

If the insurance company won't cover it, apply for Rex Assist. Our son's special care nursery stay after his birth wasn't covered by my insurance but Rex Assist covered the whole thing, which was awesome. It'll depend on the cost of the treatment relative to your income, but they're really good about working with you.

I'd assume that changing the diagnosis would take care of it with the insurance though.

12/16/2010 3:44:29 PM

Quote :

"TO THE HIS"

12/16/2010 4:21:58 PM

$1400 for oxygen. I'd hate to know what it would have cost if they had actually treated me.

12/17/2010 9:42:26 AM

Damn When I took my fiance to the ER for an asthma attack two years ago, the whole visit, including the oxygen thingy, being seen by a real live doctor and some prescriptions only cost us $30. Gubnet healthcare ftw

12/17/2010 10:29:53 AM

yeah, I will have decent insurance again come Jan. 1st

I was seen my a PA that was operating under someone's MD license. I don't really understand how that is legal. My Mom said that basically if something goes wrong and I die or whatever, then the MD gets the blame instead of the PA that treated me. Shenanigans!

12/17/2010 11:11:51 AM

words ITT

[Edited on December 17, 2010 at 11:18 AM. Reason : I thoguht Obama was making insurance free]

12/17/2010 11:18:34 AM

Quote :

"I was seen my a PA that was operating under someone's MD license. I don't really understand how that is legal. My Mom said that basically if something goes wrong and I die or whatever, then the MD gets the blame instead of the PA that treated me. Shenanigans!"

Thats basically what a PA is, a doctor without malpractice insurance. They work under a doctor and have to get certain things signed off by the doctor beforehand, but otherwise they're free to diagnose and basically function as a doctor.

12/17/2010 11:31:16 AM

Yeah, we're hoping to get through to the MD one way or another. Seems like that is our only option, because the numbers they give us are only to inept billing offices that can't connect us anywhere else.

12/17/2010 11:47:53 AM

A couple of suggestions, that may already be mentioned....

1) Call the ER, and ask for them to page the PA or her attending. Discuss the situation.
2) Call the hospital, and lodge a complaint. Most hospitals take complaints very seriously. I would start with a complaint before calling billing. They are going to take the charting as the gospel, and as you have already found out, will not resolve much. To them, you are another bitching customer that just doesnt want to pay their bill.

My wife is a nurse practitioner, so I know some good ways to approach this.

12/17/2010 12:55:18 PM

I like how the first 5 responses ITT were:

"Oh yeah totally easy to get a diagnosis changed"

then the next 5 were

"Wow, it sucks that you're not getting any traction on this problem"

then the next 5 were

"You're pretty much screwed."



I would follow what CarZin says though, lodging a complaint is a good place to start.

[Edited on December 17, 2010 at 3:13 PM. Reason : asdf]

12/17/2010 3:12:57 PM

^yeah pretty much

^^That's some great advice, thanks!

12/17/2010 3:37:23 PM

Automatic weapon rampage.

Be thankful they didn't want to hold you for observation. With your 'condition', if you had said, "No, I'm going home." they would have restrained you. Ever tried to prove you don't have anxiety? You can't. Once you sign the consent for treatment, you're their bitch.



[Edited on December 17, 2010 at 10:20 PM. Reason : .]

12/17/2010 10:01:14 PM

The hospital should change the diagnosis - I have nothing to back this up other than common sense:

Would you rather:

- be guaranteed getting paid by diagnosing something correctly that is covered.
- gamble that the person is either wealthy, or won't fight the exorbitant charges.

Seems like the hospital should default to the covered charges. It is hard to collect on medical bills - better to make sure a patient is covered.

Sounds like a new nurse who didn't know her insurance rulez.

12/17/2010 10:50:17 PM

wdprice3

12/18/2010 9:45:07 AM

see if they will work with you, but the first time they threaten collections

send them $10 a month, from now till kingdom come

they cant do shit as long as you are paying something

they will send you mean letters and calls, but just ignore them

12/18/2010 11:05:10 PM

didn't you ask to be seen by an MD? did she get any pharmacologic breathing treatments other than the supplemental O2 i.e. nebs, roids?

12/18/2010 11:25:10 PM

seems like there is more to this story...

12/18/2010 11:45:08 PM

there's always more to the story when it comes to people whining about medical care/insurance

12/18/2010 11:56:27 PM

^^, ^really broad? like what? please tell me your account of the story as you remember it.

^^^The nurse did all of her tests (oxygen levels, heart beat, etc) and decided that bmel had hyperventilation. At that point she put an oxygen/rebreather mask thing on her face to help her recover CO2 that she was losing. I'm not sure if she was hooked up to oxygen since her O2 levels were 100%.

In private, I was telling Brandi that I wanted to argue more with the nurse but she wanted to go home, as she said earlier in this thread. Since her wheezing/gasping had declined (declined, not gone away), the nurse saw bmel was fit to leave if she wanted (she did) and bmel was discharged.

I didn't say that I wanted to see a doctor. I do not frequent the emergency room, I didn't know I could, and as far as I knew I thought just arguing with the nurse was as much as I could do. Next time I will demand a doctor at the door.

The extent of my arguing with the nurse was telling her that bmel had an asthma history, questioning the symptoms or lack thereof that led to a hyperventilation diagnosis, and again going over bmel's lack of stress and asthma history.

All I'm in here for is to see people's experience in getting the bill changed so her insurance can cover it.

[Edited on December 19, 2010 at 12:08 AM. Reason : lkj]

12/19/2010 12:05:59 AM