Medical Transport External Appeal Review – $375,000

TLDR; I need advice on what to send to the External Appeal Review about a denied Medical Transport. The cost denied is more than $375,000.

All the Details: My child, then 20, was very ill at my local hospital. They needed specialized treatment not offered in our state. I found a treatment center in a few states over. Doctors in both hospitals urged immediate medical transport, but the medical insurance would not approve it. The next day, my child was getting weaker, the doctors were alarmed, and so we went without insurance approval. My child signed a paper and off we went. No fee was discussed. [Papers were to give medical insurance payments over to medical flight company, giving medical flight company legal right to pursue case, and medical file access.]

I'm happy to say my child recovered. We are very satisfied with the decision to go when we did even with this surprise bill. If we had waited, my kid likely would have been trapped with a medical team that could not provide appropriate support.

(I think this might meet the "No Surprise" bill? I about fell over when I opened the first bill.)

The medical insurance company has worked with all our other providers, all in-network, and paid the bills. We are very grateful to have such excellent insurance. We paid our OOP maximums, they have paid the rest.

The medical transport company is handling our case. But this weekend we sort of snapped to attention – what happens if the transport company tries to get payment? They promised not to pursue payment if the insurance company won't pay – but I don't think I have that in writing.

Question 1:

What to send to the external appeal committee? I read through the medical records and they are incomplete -surprising as they cover 8 days and I have 300 double printed pages of the record.

Question 2:

Could I ask for an extension of my time to submit materials?

We were hoping my spouse's company would help us through this but they just sent a last minute email saying they "rely on the medical insurance company's expertise in these matters."

Sorry this got so long.

submitted by /u/peasuspendedinjello
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