Anyone ever paid for an ER visit OOP?

janda426 · May 2014

Fuck the universe and its shitty timing for real. H just got dropped from his dad's insurance on his 26th birthday last month and has been in the process of switching to Horizon with his employer. We are pretty sure there was only a one month grace period with his dad's insurance which ran out on the 12th but since they're closed we can't figure that out exactly.

Fast forward to yesterday H started having abdominal pains in his hypogastric region (below the belly button) and has been having pain with urination. It's been 36 hours with this pain now. I'm worried about a bladder infection. And with no clue about when his insurance will kick in I'm not comfortable hanging around waiting for this to travel to his kidneys.

I worked in the ER, I know the price range this visit could cost us. What I don't know is whether or not his insurance would potentially backpay us for the bill? Has anyone had experience with this? I mean by the time the bill has been sent out in a few weeks he'll probably have his coverage up and running (which, go fucking figure since he hasn't had an ER visit in his entire life and now it becomes necessary as soon as he's cut off)

It's late on a holiday weekend and there probably won't be much action on this post but figured I'd put it out there. Every google search leads me to dumbass articles about ACA.

amylee545 · May 2014

Oh no that sucks! I'm pretty sure (someone correct me if I'm wrong) that insurance won't back cover and pay for something that happened before you were under their coverage.

I hope you guys are able to figure something out and he feels better soon!

amylee545 · May 2014

Trying to edit my post, but mobile is being awful.

Do you have a walk-in clinic near by he could go to first thing in the morning? That would be significantly cheaper than the ER would be.

Ducktale · May 2014

Yes, losing insurance on his dad's coverage counts as a qualifying event. He can enroll with his employer and back date to the first day of eligibility (the day he lost his original coverage)as long as he completes the enrollment in time (I had 30 days to enroll). They should back cover the bills that happened back to the point coverage began.

Eta: sorry for YH, hope it's nothing serious and he feels better soon.

AggieBeth06 · May 2014

I don't know but doubt they would back pay.

Not sure what state you're in, but maybe you have something like this available in your state:
https://www.bcbsnm.com/coverage/individual/temporary

They do have sales hours on Sundays.

kwicks · May 2014

Ducktale said:
Yes, losing insurance on his dad's coverage counts as a qualifying event. He can enroll with his employer and back date to the first day of eligibility (the day he lost his original coverage)as long as he completes the enrollment in time (I had 30 days to enroll). They should back cover the bills that happened back to the point coverage began.

Eta: sorry for YH, hope it's nothing serious and he feels better soon.

This.
I believe they will cover retro to the date he applied for the employer-sponsored insurance. Assuming he's already done that you should be ok.

Hopefully everything gets worked out and he starts feeling better!

Ducktale · May 2014

amylee545 said:

Oh no that sucks! I'm pretty sure (someone correct me if I'm wrong) that insurance won't back cover and pay for something that happened before you were under their coverage. I hope you guys are able to figure something out and he feels better soon!

They should cover since he was eligible at the time. For example, let's say I left my job on May 1st, so my coverage with that employer ends on May 1. I have a period of time (30 days? 60?) to complete the enrollment paperwork with my husband. Say I go to the doctor on May 10, with no active insurance. I complete the paperwork on May 20, but they backdate my coverage to the first day I was eligible on May 1. So they cover the doctor bill (I also obviously would owe premiums for that time as well)

KatzKiss · May 2014

You can try to file a claim but if you pay them up front, they usually won't cover it. If I were you, I would talk to the financing department at the hospital and arrange a payment plan. Then when H gets insurance, send in the claim immediately. You might have to make some payments in the meantime but it's better than paying everything. ERs, in my experience, don't make you pay up front for emergencies so that will buy you a little time. I can't promise they will cover it but If you pay them up front, I grantee you won't get anything back from insurance. If they see that you have the money, they will keep it.

ETA I missed the part about receiving a bill. Obviously you know they won't make you pay up front. Also, bladder infections are very rare in men so that might not be the problem. If it is, you want it looked at ASAP because it could turn into a kidney infection.

DaBearsFansWife · May 2014

Insurance won't back pay. I was the days away from being insured. I now owe the hospital $4,000 anyway.

janda426 · May 2014

Wow thanks for all of the quick responses. He just formally sent out the application to his HR (he works for the government so HR is all the way in Kansas City) Friday because that was the first day we got back from the trip. He turned 26 on April 12th and we believe his coverage ran out May 12th. I had been on his ass about getting this taken care of so needless to say I'm more than pissed off that this is happening now (obviously caring more about his health but still, his procrastination might cost us a fuck ton of money). I'm worried he may have went past any qualifying dates to get back pay. We definitely won't pay anything until he hears back from the insurance though, hopefully this week. @rentaduckie‌ we have urgent cares but they all immediately send you to the ER when they hear you don't have insurance. Trust me I wouldn't ever go to the ER for a UTI since I get them all the time. If they're his only treatment option at this point though, were kind of screwed. @SmileyGirl18‌ I don't know if cobra will even come back in time since he's already in the process of getting on his permanent insurance. Gah, this sucks. Only our luck....

nikollee · May 2014

Ugh, that sucks. Same thing happened to me, I've always been pretty healthy, a week after I turned 26 I got a kidney infection. Not fun! I'm not positive how back pay works, but he should see someone before it progresses to that, a kidney infection was quite painful. Good luck, hope he feels better soon.

janda426 · May 2014

Crisis averted-- apparently his dad's insurance is still active. Randomly. They said it would be ineffective after a month. Guess the odds were in our favor this time? They think H pulled a muscle in his lower belly. We're about to leave the ER, get some hot bagels and sleep all day.

PrimRoseMama · May 2014

Glad that it isn't more serious & that the insurance was still active. Enjoy your bagels & your sleep!

catmagick · May 2014

Thank goodness it was nothing more serious!!! Glad it all worked out for you @janda426 . Pulled muscle......must have been all that European sex ;-)

catlover790 · May 2014

I'm glad everything worked out okay! I hope your DH feels better soon, so glad the insurance worked anyway.

chaysefaith · May 2014

@janda426‌ I work for a health insurance company, so you may want to keep an eye on paperwork coming through for this. Generally insurance policies term you at the end of the month in which you turn 26 (so April 30, for your DH) which means he might still be actively covered through his dads policy in error right now.

In addition to that, his employer should back date his coverage back to the original date of his plan terming, which if it does end up being April 30, or even May 12, his insurance through his employer would be his primary insurance and would need to pay as primary.

I say all of this because what could eventually happen is his dads insurance gets a retroactive notice from the employer to terminate the plan on a specific date, they do, and then they go back and request a refund on everything they paid for claims after that date. Everyone then sends the refund and sends you the bill. All these refunds and take forfuckingever, which means by the time this all happens it's too late for everyone to rebill to your DH's insurance and you might end up getting stuck with the bill anyway.

My suggestion would be to have him call the hospital as soon as he gets his new insurance card and give them that information and tell them that all of his claims need to be rebilled to his insurance.

TL;DR: your DHs insurance through his employer his primary if it will have an effective date on or prior to yesterday's date, once he gets his cards he needs to supply that info to the hospital to avoid you guys ending up with a huge insurance mess.

shlittertoots · May 2014

That's great that the insurance worked out and I hope YH heals quick!

janda426 · May 2014

@catmagick‌ lmao I personally thought it was from him hulking out and picking up both of our suitcases up the stairs haha

@SNLT1012‌ thank you we will definitely give the hospital a call when H insurance info comes through!

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