Anthem Rejecting Most of Our Emergency Claims

My wife and I were in a terrible accident this summer out of state when a second story deck collapsed at a country club. Between the two of us, we have 16 broken bones, lots of soft tissue injuries, internal bleeding and a brain bleed. Two surgeries were required for my wife and now we are going through a long physical therapy process. Anthem has rejected many of our claims as being out of network even though it’s my understanding that emergencies have to be treated as in-network. Am I correct in this thinking and if so, why do insurance companies play these games? I’ve spent hours per week fighting with them versus focusing on my recovery which is very frustrating. They will most likely be reimbursed 100% through the country club which we are suing and I’ve appealed all rejected claims but their appeal process seems long and lengthy. In the mean time, the hospital and doctors are now pressuring us to pay our bills. We pay around $20,000 annually for our health insurance and we have a $15,000 family deductible so it’s incredibly frustrating that we are seeing bills approaching $100,000 and our insurance company keeps sending us denials as out of network. I even got pre authorized for one of my treatments as it was occurring almost three weeks after the accident and we were still out of state waiting for doctors to release my wife and I thought they wouldn’t consider it an emergency by this time. They called me and said I could get treated but now they are denying it because the doctor used a different cpt code. When they authorized it they called me and said I was authorized to get my wound treated but they never gave me a cpt code and it wasn’t till several weeks later when I received a letter at home what cpt code they approved. Has anyone else been through this and what did you do?

submitted by /u/Different_Pen2314
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