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Serious Overdosing - will a trip to the ER be covered by health insurance? Nervous

Xorkoth

Xorkoth

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Hey all, well to make a long story short, a few weeks ago I "overdosed" on GHB and my girl found me unrespective but breathing. She didn't know what was going on and couldn't wake me after like 15 minutes and my pupil;s were tiny pins so she assueed, given my history, it could be an opiate OD and called 911. Paramedics and cops showed up, they gave me a shot of narcan, and I started to come to, I was super confused. I had no idea what happened or what day it was or my address or anything, so they said, despite my girl saying she thought I was making improvement and would be fine, that it was policy for them to take me into the ER.

So they did... gave me an IV, fluids, kept trying to get info out of me. At the hospital I kept saying I didn't remember taking any drugs (I didn't at that point) so they gave me a CT scan and blood work and a urine screen. I came to pretty quickly though as GHB is short-acting, and was coherent again. Called my girl, she had called some friends, and they told her probably GHB, and when she said that I rememebred. I had already talkeed to the first doctor and I got someone's attention andf said I know what happened, I feel better and I'm ready to leave. No one tried to tell me to stay, another doctor came in and lectured me a bit and I told him I remembered I had taken GHB, which he did not seem to write down or anything. Then I signed some discharge papers (no one was saying I left against medical advice or anything, at least not to my face). Then my friend picked me up and I went home and was fine.

Then a week later I saw in my health insurance that my insurance got charged $5000 for the ER visit (and only $90, separately, for the CT scan). So $5k for a narcan shot, 15 minute ambulance ride, blood test and urine screen, and 2 doctors lecturing me. Jesus christ wtf is wrong with America's health system? Anyway... fast forward to today, I got a voice mail from my health insurance company just saying to call them back. Clearly it's about the ER visit. I got nervous about it since it was an OD, and started looking things up and finding out that some health insurers are denying coverage for ER visits if, after the fact, the ER visit was deemed medically unnecessary. Now I think mine was absolutely medically unnecessary. But, they also gave me narcan and forced my girlfriend to let them take me to the hospital. I'm afraid of being on the hook for $5,000, whereas if they do cover it, I will only owe $400 (my deductible).

Does anyone have experience with this sort of dilemma? I want to be informed before I call the insurance company back. I'm not sure whether them knowing it's an OD would make them not cover me? Or would they consider it medically unnecessary based on certain factors? How much do they already know (I imagine not a lot due to patient confidentiality... so how I frame the story might determine whether they cover this or not)?

I just really don't want to get fucked and owe 5 grand for basically nothing. I'm grateful to them for responding, and my girl did the responsible thing. They were just doing their job, what I am sketched out about is the insurance company trying to screw me (and the fact that the hospital could somehow get away with charging 5 thousand dollars for this). I've never had to use my health insurance one time besides routine doctor visits in 15 years of having it, but I am going into this assuming they're going to try to weasel out of paying and I want to be prepared.

Thanks
 
As long as you make a small payment every month, the bill won't be put on your credit.

They may very well say that the trip was unnecessary, however, you were unconscious and the EMTs deemed it necessary to transport you to the hospital, and you could very well argue that fact.
 
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I'm not sure really. The shitty thing about it is that everyone's insurance functions differently and it's so convoluted so people really just don't know.

I thought if you were covered to go to the ER, than you're covered if there's an emergency, just pay the 500 or whatever it is. Didn't realize they could do that to you, but I'm still kinda figuring some of this stuff out myself.
 
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This is the really fucked up thing too... take me for example, I've had to get all my hospital debts forgiven because I'm too broke to have insurance. But someone responsible like you who does have it probably wouldn't get the same luxury even though the bill is still astronomical.

I mean, I don't think it would be a waste of time to talk to the financial dept. at the hospital about your options if the insurance people get really fucky with you.

sorry you're having to deal with this shit. The entire "healthcare" system in this country is a disaster.
 
Hey my friend.
I am so sorry that this happened and you went through this.
Thank God you are okay.
That is the main thing!!
❤️👍

I worked for insurance companies for over 15 years so let me help you.
Do not offer ANY information to them.
They probably don’t have it coded as an OD on their medical claim.
Just stick to, you don’t know what happened.
If you HAVE to you could always say that you tried some new supplements (I have seen some that contain GABA) and must have had a bad reaction or maybe low blood sugar or something.
Do not mention illicit drug use to the insurance company.

The ambulance is going to probably be the most expensive part as the ambulance companies are not participating providers on any insurance plans I know of.
But they are good about letting you make payments.
Hopefully they took you to a hospital that is a participating provider with your insurance.
If not, you will owe the difference.

They should cover this though.
It was a medical issue.

Call them and see what they want and just be vague.
If they put you on the spot just say that you need to check with your girlfriend as you were unconscious.
then come and tell me what they said and I can better advise you.
Send me P.M if you want.

This will work out.
I am not sure why they would be calling you though.
try and see what they want while at the same time giving them no information.
 
I have never heard of insurance being able to deny coverage for an OD. The ambulance trip will be on you though because even if you have ambulance coverage, it will be denied if it is deemed that it wasn't an emergency (which is why I didn't go to the ER when I was deathly ill back in December because I didn't want to have to pay the ambulance bill regardless of my 104 fever, chills, and my lungs feeling like they were being run through a meat grinder (which are all COVID-19 symptoms apparently so it looks like somehow my roommate's kid and I got it back then)).

$5K is the bill sent to the insurance. If it ends up being self pay, the bill normally ends up getting chopped significantly. Probably would be looking at $1200-$1500. Still isn't great but much better than the original. Make sure you work with the hospital ASAP so they don't send it to collections but legally medical collections cannot go on your credit report until 180 days so you have plenty of time before it damages your credit.

Glad that you're okay!
 
Just an FYI for everyone-

It is important for your girlfriends, wives, boyfriends, husbands, to know which hospitals are “participating providers” with your insurance company so that if you are in a situation like this they can request the ambulance to deliver you to the hospitals that are participating with your insurance.
Ambulance people will usually ask “which hospital does your insurance cover?”
so it is important for you and for significant others to know this information.

If you are in heart failure or something like that then they will just take you to the closest hospital.
 
Thanks guys. We're trying to figure it out. I'm just sketched out that my insurance company is calling me, and in the messages they left (3 days apart, just noticed the first one today when I missed the call and they left the second one), they didn't say why they needed to talk to me. I mean they have at least as much info as I do. Don't know why they need to call. So I'm imagining they're probably trying to see if they can screw me. But maybe not? I just don't want to get on the phone, and be on the spot, and say something wrong and get hit with a big ass bill.

Basically the EMTs told my girlfriend they were required to bring me to the hospital after I was awake and I couldn't respond successfully to questions, she said she wanted to just take me to urgent care since I was awake and they wouldn't let her and forcibly removed me from my house.

The hospital is covered by my insurance, fortunately. I just don't get why they have to call me about it?

PYTH said:
I'm a little bit surprised, when I had a CT scan during an ER drop-in (no ambulance) a decade ago the scan alone was north of $7k without insurance, maybe more like $11k. My total uninsured bill was $15k for basically an IV, a bed for a couple hours, and a CT scan.
Click to expand...

Yeah my buddy had a CT scan done at the ER without insurance and they charged him upwards of $10k. I saw the charges and I got 2 charges, one was for "emergency room visit", and was like $4700-ish, and the other was for "lab work/CT scan" or something like that and was $175, and then it said health insurance discount cut it to $90.
 
Xorkoth said:
Thanks CFC, me too. I may very well be overthinking. Just nervous to call back and get put on the spot and say something I shouldn't have and get screwed.
Click to expand...

It's not overthinking - it's wise to do the research and have some idea what they could hit you with in a situation like this. I prepped plenty in the past for travel insurance claims I've made, and also for claiming on the policy when my Mum was raced to the ER when we visited the US last year. Fortunately I managed to sweet talk them till we got her down to paying a total of $0 from her almost $13,000 bill!
 
I don't want to alarm you and it really won't affect your credit, but I got thousands of unpaid hospital bills from overdoses. Insurances won't cover shit. My ambulance ride which was 15 minutes cost me $1,700. I told them to go fuck themselves I'll never pay that. I was forced into the ambulance I denied hospital treatment and the police said if I didn't go I'd get arrested.

It's all a big fucking money scheme.
 
I cant believe you got out of there for 5 grand. I drove myself in with a really bad headache and walked out three and a half hours later with over a 15000 dollar bill and I still had the headache. I wouldn't bring this up with your insurance right away. See if it just slips through and they just pay it.
 
The Wizard of the Creek said:
I hate to be the elephant in the room. You did O.D. and were transported to the nearest hospital. Because of that, you are alive and typing here. People get pissed and demand money from you when you unnecessary waste their life saving skills on whatever combinations of drugs that you took, and led you their ER department unresponsive.

Chalk it up as a mistake (it happens to the best of us) and pay them for their services (within reason) and move on and do drugs better in the future.

I can’t say that any simpler,

—Wizard
Click to expand...

I appreciate the medical professionals and thanked them several times. I am appreciative of the service I received and am grateful for it, what I am trying to avoid is my insurance company fucking me over, when I pay them for the possibility that I may need their coverage if something happens (like this). I want the hospital to get paid, I just want my insurance company to pay, and not me. Otherwise why have I been paying them $150 a month for the past 15 years?

So I'm landing on, don't volunteer any info to the insurance company, definitely don't tell them why I went. If they need me to tell them, I will say I lost consciousness for unknown reasons and was transported to the hospital while I was unconscious.

I do think it's insane that an ER visit costs so much, and it's a sign of our health system being badly broken. But the insurance companies are the problem, not the hospitals.
 
I would't even respond to those
phone calls because they are ALL
just SCAMMING. More or less, but mostly more.

Just wait until you see your bill in
writing or font and then dispute it.

But I would NEVER ever talk on the phone
like that when they are catching you off guard.
They have your address and they can send it to you in writing. And they won't.

Point, you do not need ten random phone calls
to resolve.

But I cannot tell you directly what or what not
to do. But I do know that those phone calls are NO GOOD. And really I have always ignored them and the problem always took care of itself sort of thing.

But like in the posts everyone's case or situation is unique.
 
Dang. Just imagine what an MRI costs. I had to rush into the emergency room a couple years ago when I had an infection in my ankle (non-drug related, just a freak infection with swelling) and they did an MRI as well I guess to see if I'd injured myself. I was laid up in there for 4 days on Oxycontin

Thank the gods I'm on disability or I'd be dead
 
PYTH said:
I'm a little bit surprised, when I had a CT scan during an ER drop-in (no ambulance) a decade ago the scan alone was north of $7k without insurance, maybe more like $11k. My total uninsured bill was $15k for basically an IV, a bed for a couple hours, and a CT scan.
Click to expand...
Yeah I actually was a bit surprised at the cheap bill too.
The Wizard of the Creek said:
Just be like me with ER visits:

Fuck you bitches, out of my cold dead hand!

ER visits do not reflect negatively on your credit, or any reporting entities. You could theoretically, go to the ER every single day, for the rest of your life, and your credit will not move an inch. You DON’T have to pay the ER for any of the tests they did. They will have to eat that cost. Period. The healthcare system in the US is fucked. The point is, you’re credit will not be fucked by not paying their astronomical bills for your ER visit.

That is as correct now, as it has been for decades. Just don’t be an idiot and start making payments. Then you’re fucked, that’s intent to pay type of shit.

Don’t take my word for it, look up ‘paying back the ER’

hope that helps

—Wizard
Click to expand...
Umm. Unpaid hospital bills definitely go on your credit. My 20K trip to the hospital when I tried to kill myself followed me around for 6 years before it fell off when the hospital failed to respond to a dispute I put in because I couldn't even reach them, updated every month, suppressing my FICO scores 60-90 points depending on the bureau. I had 4 different medical collections on my reports at one point, all from ER visits. I got the last one off in 2018 finally.

They won't sue most of the time but they do indeed wreck your credit.
 
The Wizard of the Creek said:
Not for the ER and not if you don’t give them any ‘intent to pay‘

You’re wrong
Click to expand...
I'm not wrong. I know for a fact that they do go on your credit. I help people on a credit forum to get this shit off of their reports. There is no law barring it as it is a debt. I have even ended up with the bill on my credit when I was not capable of giving them my information - they pulled my ID from my wallet to get me in the computer. They pass the debt to debt collectors who then put it on your credit. The only real rule is that a medical debt cannot be listed for 180 days to give people time to settle it.

Intent to pay only comes into play when dealing with a debt collector since any intent to pay makes the debt valid (and they can then sue you and win easily). Services rendered in the ER automatically generate a debt owed.

www.experian.com

Can Medical Bills Hurt Your Credit Report? - Experian

Your medical history is not part of a credit report, but past-due medical debts can affect your credit reports if a medical bill is left unpaid. Learn more.
www.experian.com
 
The Wizard of the Creek said:
Nope, not for the ER. Just don’t give them any intent to pay, and your credit will not move an inch. This has been the case for decades. If you give those creditors any intent to pay, than yes, you are on the hook credit wise. It sounds like you made a mistake and are now paying for it.

Your still wrong
Click to expand...
Educate yourself. A trip to the ER creates a debt, it's only when you deal with a collection agency that you can trap yourself by admitting the debt is valid (which doesn't even require intent to pay).

www.experian.com

Can Medical Bills Hurt Your Credit Report? - Experian

Your medical history is not part of a credit report, but past-due medical debts can affect your credit reports if a medical bill is left unpaid. Learn more.
www.experian.com

The minute a collection agency gets assigned a medical debt that is beyond 180 days old, it can go on your credit. I didn't even know I had them until I decided to fix my credit in 2018 and pulled my reports.
 
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