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Q: Health Insurance Won't Cover ER Trip
asked by: reswd5 on September 28th, 2009
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My husband has health insurance. He went to the ER over a holiday weekend for severe pain in his mouth. He received a shot for the pain and medication to hold us over the weekend until we could get to a dentist. Now the insurance company won't pay for the physician's bill or the ER bill because they are saying it was a tooth-related illness. We're not asking that they pay for the root canal we had done at the dentist, and my husband didn't have any surgery done at the ER, the shot he received was not even administered in the mouth. How is it possible that they won't pay for this? We haven't paid any of the bills yet. What would you suggest in terms of filing a claim? Would it be worth it to try?
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zigemyster
replied on October 6th, 2009
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Unless his policy clearly states that mouth pain is not covered in the ER...

Most policies will cover ER visit with the patient paying a copay (like $100) unless admitted to the hospital in which it would be waived.

It could be that whoever processed his claim felt that the visit would fall under dental & was denied in error. It happens.

He needs to appeal this with his insurance carrier. It was a visit to the ER...not for a routine visit but for dire pain.

Zig
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