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Ok, so any help on some health insurance woes?

Riverson

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Your post "That bill was 20K for 6 hours of care, exrays, CAT, sutures, whatever.

Anthem refuses to pay any more than 5K "because Arrowhead is not in their network".


I agree with Dave that you need to dig into your policy to see what is covered, what is excluded, limits of coverage, exceptions and most importantly the methods available for dispute resolution (mediation, arbitration).

Our company handles CA workers compensation and employers liability. The hospital bill you received is the rack rate/cash customer charge for each and every service you received as a patient (services, tests, medications, durable medical equipment, supplies). Did Anthem actually pay $5,000 or was that their offer to pay? Is this amount the limit of coverage for an out of network provider or is it 25% of the billed amount? Where the charges reviewed by Anthem---what would the bill be if it was a network hospital? I can tell you that a network reimbursement amount under the network contract is going to probably be less than half of the full rate billed by the hospital.

You will want to gather information, have a multiple angles of attack and defer any agreement to pay.

Good luck...if you have additional information be sure to reach out.


This is great advise! He is dead on with charges not even being close to what is recovered. Margaritaville, who do you work for? We may be on different sides, but I am sure we know each other! I may have even taken your testimony. My companies represent payees not carriers.

Is this Teddy or Milt? My guess is you are Milt?
 

wsuwrhr

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Was this a single vehicle accident?
Was there anything out of the ordinary that may have caused this accident?
A few years ago, in Northern CA, a motorcycle hit a pothole and had major injuries.
Nothing out of the ordinary, until investigation showed another motorcycle had hit the same pothole 6 months earlier.
Game changer..........

No,

A car turned left across opposing traffic to cross my right of way. I flew into the windshield and off the roofline into flight school training. I wasn't speeding, and have no marks on my driving record. This was the other driver's second "at fault" accident in less than 8 months.

Police report depicts the accident correctly and puts me not at fault.
 

spotondl

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No,

A car turned left across opposing traffic to cross my right of way. I flew into the windshield and off the roofline into flight school training. I wasn't speeding, and have no marks on my driving record. This was the other driver's second "at fault" accident in less than 8 months.

Police report depicts the accident correctly and puts me not at fault.

Why are you even dealing with any of this? Sounds like your personal injury attorney should be on the other driver and their insurance like white on rice...
 

wsuwrhr

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Why are you even dealing with any of this? Sounds like your personal injury attorney should be on the other driver and their insurance like white on rice...

Because he is a fuktard attorney.
 

LuckyDaze

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Brian not a single penny should come from your pocket for the injuries you sustained on that accident. If the other party is at fault get on the horn with their insurance and raise some hell. If they give you the run around feel free to hit me up, I have been working with insurance claims and in the insurance industry for the past three years. I may be able to help you skin that cat.

I am sorry to hear you are going through this. Anthem dicked me around back when I had them too. It is insanity some of the things that are happening out in our country. Keep picking at em and you'll get it taken care of.
 

spotondl

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Because he is a fuktard attorney.

Time for a different attorney... No joke...

Brian not a single penny should come from your pocket for the injuries you sustained on that accident. If the other party is at fault get on the horn with their insurance and raise some hell. If they give you the run around feel free to hit me up, I have been working with insurance claims and in the insurance industry for the past three years. I may be able to help you skin that cat.

I am sorry to hear you are going through this. Anthem dicked me around back when I had them too. It is insanity some of the things that are happening out in our country. Keep picking at em and you'll get it taken care of.

^^^^^ THIS!!!

Your personal injury attorney should be on this on your behalf... You shouldn't even have to be paying your PI attorney any $$$... This is a contingency fee attorney's wet dream... With the extent of your injuries, recovery time, and permanent damage you're into the high six figures, possible 7 figures...
 

wsuwrhr

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Attn says "Case settled." Something to the effect of "Athem won't pay, the ER bill is your responsibility sot it will come out of your share of the settlement. Sorry about your bad luck. Thanks for my percentage. Case closed. Good luck."



Brian
 

wsuwrhr

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His case summary letter was an Oscar winner for sure.
 

wsuwrhr

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I wish. I am at 45K in just lost wages. I had to borrow money just so I wouldn't lose my business or newly purchased house.

The "at faults" party policy limits were nowhere near that high.

With the extent of your injuries, recovery time, and permanent damage you're into the high six figures, possible 7 figures...
 

LuckyDaze

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Did you carry uninsured/underinsured motorist on your bike policy? If you did your policy can pay out if they didn't have enough coverage to take care of your damages.
 

wsuwrhr

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Attn was a straight up lazy fuk.

Pretty disappointed in the whole deal, and I resigned myself to just be happy I got out with my life and limb somewhat attached.

Brian
 

wsuwrhr

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Did you carry uninsured/underinsured motorist on your bike policy? If you did your policy can pay out if they didn't have enough coverage to take care of your damages.

No. I had liability only. My logic in selecting insurance coverage on my bike was seriously flawed. A big mistake on my part.
 

wsuwrhr

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Did you carry uninsured/underinsured motorist on your bike policy? If you did your policy can pay out if they didn't have enough coverage to take care of your damages.

Better than that, my policy paid me $1500 for "uninsured motorist", and they liened my settlement for that $1500 as well.
 

LuckyDaze

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No. I had liability only. My logic in selecting insurance coverage on my bike was seriously flawed. A big mistake on my part.


I am sorry to hear that man. Today is my last day in the insurance gig as I got a better paying job but I still have the knowledge. If you ever want an insurance audit to make sure you have no gaps Id be willing to lend whatever knowledge I have.

What a shitty deal man. Of course you know you can go after the person who hit you, but if they were carrying state Min's chances are getting money from them would be like squeezing blood from a turnip. I know in WA you can attach future earnings for gaps in coverage, not sure if you can receive some sort of re-imbursement for the damages over time this way through Ca.
 

wsuwrhr

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Thanks,

I already had a super cool "leave no stone unturned, look under every rock under every rock" Private investigator, and she has nothing, owns nothing, loser fuk bitch, who can't drive , that did the same thing, to someone else, 8 months prior.

What a shitty deal man. Of course you know you can go after the person who hit you, but if they were carrying state Min's chances are getting money from them would be like squeezing blood from a turnip. I know in WA you can attach future earnings for gaps in coverage, not sure if you can receive some sort of re-imbursement for the damages over time this way through Ca.
 

LuckyDaze

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Thanks,

I already had a super cool "leave no stone unturned, look under every rock under every rock" Private investigator, and she has nothing, owns nothing, loser fuk bitch, who can't drive , that did the same thing, to someone else, 8 months prior.

:( Thats a raw deal all around.
 

spotondl

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I wish. I am at 45K in just lost wages. I had to borrow money just so I wouldn't lose my business or newly purchased house.

The "at faults" party policy limits were nowhere near that high.

That sucks for sure... However, her policy limits are not the limit of your potential judgement... I read further down that this woman is basically judgement proof meaning that even if you got a reasonable judgement that she has no assets to go after to exercise your judgement. Definitely a bad turn. Judgements however follow a person for a long time... If she ever comes into some money or assets at least you'd be in line for a cut... You probably already know that though...
 

wsuwrhr

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You signed a release of liability, without prejudice? YOU have to sign off on any "settlement"...

Yes, I settled the case...at the time the ER deal was still in "Grievance". I was defaulting on payments, out of options and needed the nickels.
 
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