Dealing with Health Insurance Company
Anyone have any experience working with for health industry. My brother breaks his ankle and leg, goes to emergency room at participating hospital the morning after accident. They tell him it is too swollen to do anything ...to see a doctor. He sees a doctor who is part of hospital and Oxford Health plan but not my borthers health plan. Surgery occurs within 2 days of initial visit to Emergenct=y room and should have been treated as emergency. Apparently authorization did not occur and it was not pre approved. The removal of screw....broken I moth add...were paid by insurance company.
Anyone have expertise in this area. Best I have heard is that it was "fragmented emergency room service". Oxford pays nothing if out of network. Sure wish hospital took care of ankle on day of initial visit.
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