Difficulty getting reimbursed for urgent care in Spain
My mother was hospitalized in Spain in early June. She suffered a fall which resulted in an open fracture of her arm as well as two pelvic fractures. She was transported via ambulance to the nearest emergency room. She was stabilized and her arm set at this emergency room then transferred to a private hospital where she had surgery on her arm and remained there for nearly two weeks due to the pelvic fractures. We immediatley contacted Kaiser on day one who advised us we would be paying out of pocket and then submitting a claim for reimbursement upon her return. So far our claim has been denied for what seems like ever evolving reasons. Initially they stated there were duplicate bills (there were not), now they are stating they require ICD-10-CM diagnostic codes as well as HCPCS (service codes) or the claim will be denied. My understanding is that while Spain uses ICD-10-ES probably for statistical and tracking purposes they do not employ HCPCS codes for claims or billing, probably because they are a public health care system. We did submit an itemized bill from both hospitals, her complete medical records, proof of travel, etc. All items that were required in the claim submission process. Has anyone else had any luck getting a foreign claim approved without ICD-10 or CPT codes? While significantly cheaper than an American hospital stay, the total around $40k, this is more than my parents can afford.
submitted by /u/leona30305
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