This is ludicrous! I have insurance, & still this will completely drain me financially. I'm at the point where I almost think it would be easier to declare bankruptcy and start over!
I worked in insurance for over five years. Not this kind of insurance, but it was a kind of health insurance.
a) Get a letter of "medical necessity" drafted by your primary care physician.
b) Call the insurance company and ask about the policies concerning emergency treatment. Don't accuse them of anything. They get cussed out all the time and it will not help you. Be nice and start from the assumption that there must be some mistake.
c) If you make no progress with that, have a lawyer send the insurance company a letter requesting a copy of your records. This sometimes makes them look very carefully at the bill and sometimes is enough to get you whatever benefits you are legally due. Which may not be your wildest dreams of avarice, but may stave off your desire to declare bankruptcy.
If you do have a lawyer request your medical records, expect the insurance company to come back with a form letter stating they need a third party auth. Yes, a lawyer will need a third party authorization to get your medical records, but I wouldn't bother supplying them with one at the start. Just make the request without it and supply it if you really need to. If you get your bill paid because a lawyer wrote them, your lawyer doesn't really need your records. The initial inquiry sometimes gets the claim looked over more thoroughly. I am basically recommending this as a scare tactic.
There are actually a lot of errors made in paying complex medical bills at insurance companies for the simple reason that the claims processor may not see an 8 day hospital stay all that often and may have about 10 minutes in which to look your bill over and decide what is payable before moving on. I had to process 60 claims a day to keep my job. This meant I had minutes to decide what the benefits were and people who were very fast were actively rewarded for it. I often cleaned up their messes and, no, this did not get me promoted or anything, even though it sometimes kept the company out of court because the people were threatening to lawyer up.
Insurance companies and hospitals "accidentally" bill you for the wrong thing all the time, even for the little stuff.
I went to the ER for a broken hand a couple years ago, got a $450 bill in the mail when I should have just had a co-pay. Called the hospital, they said I had to pay. Called my insurance, insurance company said I didn't have to pay. Got in a three way call with the insurance company and the hospital... The billing specialist at the hospital literally said "Sorry, that's a known billing error!"
I'm generally not a conspiracy theorist, but I've never heard of a medical billing error that was in favor of the patient... If you see something alarmingly high or out of whack (especially if you've done your due diligence, read and understood your policy, and researched covered hospitals) you'd be silly not to fight it.
Fixed takes a percentage of the dollar value of tickets that get dismissed and you pay nothing for the service if it is not fixed.
Trying to get money out of an insurance company is sort of the opposite problem, though it gets monetized essentially the same way. Independent adjusters monetize by taking a cut of claims paid. This is basically the same monetization scheme that lawyers use for things like suing someone over an accident: They take a cut of cases they win, and you pay nothing if they lose. As far as I know, independent adjusters only work on real estate related claims, not health claims.
Last I checked, the only people legally entitled to talk to the insurance company on your behalf are your insurance agent of record, a lawyer or an independent adjuster. So, in practice, you would be talking about independent adjusters for the health insurance space. I am not clear that would even fly, legally.
Health insurance is a pain in part because it is very highly regulated. It has to comply with both federal and state laws in all jurisdictions in which it operates and laws for both health companies and financial services companies. Thus, it is subject to both HIPAA (Health Insurance Portability and Accountability Act) and The Gramm–Leach–Bliley Act (GLBA), also known as the Financial Services Modernization Act of 1999. I got annual training in Gramm-Leach-Bliley when I had an insurance job. Furthermore, claims must be reviewed and paid in accordance with various state laws. The company where I worked kept a database of "state exceptions." If you don't know those state exceptions yourself, good luck arguing the matter with an insurance company.
You are talking about a very challenging problem space.
I have had it cross my mind to offer a service helping people file claims with the company I once worked for. Although I haven't worked there in a while and some things have no doubt changed, I probably could help some people get more money out of their policy. But I have never gotten past the idle thought stage in part because insurance is such a pain of an industry, and in part for other reasons.
I worked in insurance for over five years. Not this kind of insurance, but it was a kind of health insurance.
a) Get a letter of "medical necessity" drafted by your primary care physician.
b) Call the insurance company and ask about the policies concerning emergency treatment. Don't accuse them of anything. They get cussed out all the time and it will not help you. Be nice and start from the assumption that there must be some mistake.
c) If you make no progress with that, have a lawyer send the insurance company a letter requesting a copy of your records. This sometimes makes them look very carefully at the bill and sometimes is enough to get you whatever benefits you are legally due. Which may not be your wildest dreams of avarice, but may stave off your desire to declare bankruptcy.
If you do have a lawyer request your medical records, expect the insurance company to come back with a form letter stating they need a third party auth. Yes, a lawyer will need a third party authorization to get your medical records, but I wouldn't bother supplying them with one at the start. Just make the request without it and supply it if you really need to. If you get your bill paid because a lawyer wrote them, your lawyer doesn't really need your records. The initial inquiry sometimes gets the claim looked over more thoroughly. I am basically recommending this as a scare tactic.
There are actually a lot of errors made in paying complex medical bills at insurance companies for the simple reason that the claims processor may not see an 8 day hospital stay all that often and may have about 10 minutes in which to look your bill over and decide what is payable before moving on. I had to process 60 claims a day to keep my job. This meant I had minutes to decide what the benefits were and people who were very fast were actively rewarded for it. I often cleaned up their messes and, no, this did not get me promoted or anything, even though it sometimes kept the company out of court because the people were threatening to lawyer up.
Best.