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From: Nadine.Thomas@p1.f7.n300.z1.fidonet.org (Nadine Thomas)
Newsgroups: misc.handicap
Subject: Re: wheelchair use
Message-ID: <17756@bunker.UUCP>
Date: 9 Feb 91 05:09:59 GMT
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Index Number: 13635

 PN>    Nadine, while your policy may prevent you from making an
 PN> appointment with
 PN> another doctor, does it restrict you in an emergency from going to
 PN> the nearest
 PN> hospital emergency room.  I would try and just go to an emergency
 PN> room and drop
 PN> the problem into the doctors there lap. I also think that your
 PN> insurace company
 PN> or even the county would have a hard time fighting to pay that
 PN> bill. You should
 PN> be able to easily fight them if they try and bill you over an
 PN> emergency situation.
 PN> Just turn the pain and swelling into an emergency.

Let's see if I can explain this properly.  We have a state indigent
medical program - Arizona will not participate in the Federal
Medicaid Program - they think they can do a better job (cough,
cough).  I had to pick one of the plans when I enrolled (now they
assign plans to new enrollees) - I can change plans once a year
ONLY and that is without any knowledge of the other programs until
I use them - then I am stuck with them for another year.

When I have an emergency I have to call the doctor on call who will
deem it an emergency or not and instruct me accordingly.  If it is
considered an emergency then I have authorization to go to the
hospital emergency room (the hospital my doc is affiliated with).
If I do not have a way there they will contact the social worker to
see about getting a cab for me (paid by my plan) - If it is a more
severe emergency then they will tell me to call 911 for an
ambulance (and the plan is supposed to pay for that).  If it is a
SEVERE emergency (like bad auto accident and it is life and death)
then I can be taken to the NEAREST hospital and the plan will
consider paying for it providing they are notified within a day or
two.  If I do not follow procedure then I can and will be liable
for ALL the bills.

I had a case about a year or two ago where I had called the doc
cause I had severe pains in my leg and hip and could not walk. She
told me to call 911 for an ambulance - they came and found me
outside (I had to go outside because my dog would not allow them to
come in) and said I could walk (even though I was propped up
against the door) - my plan saw this and refused to pay the
ambulance bill - I kept getting dunning letters from the ambulance
company - my representative said she was working on it - She told
me after a few weeks that they were denying payment cause they did
not think it was necessary - I then asked her why they considered
it unnecessary since I had been admitted to the hospital that night
- her eyes got big and she said OH! and resubmitted it and it was
finally paid.  The hospital is a teaching hospital so other then my
primary doc the rest of them that I deal with are residents who
don't know their elbow from a hole in the wall.

When I visited with Betty I had to go to the emergency room - I
called my primary doc and asked permission (which was granted) - I
went to the ER and told the intake clerk that she had to call my
plan for permission and she refused all four times I asked her.  I
then got billed by the hospital.  I submitted that bill (along with
a prescription receipt) and a covering letter explaining what
happened back in OCTOBER and I have yet to hear from them (even
after several inquiries).  I have no idea if it is going to be paid
or not.  I do know that I was told that if the ER bill is denied I
will NOT be responsible because their clerk messed up and refused
to call as I requested.

Anyway - this is a brief (?) description of just ONE part of the
plan.

--
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