Hospital ED sent partner home via ambulance and insurance won’t pay (kinda complicated)
I’m in Colorado. My partner is a paraplegic. He does not use a chair and is ambulatory, but he walks like a toddler learning to walk. He has a lot of pain and little sensation. Recently he had unrelenting, horrible pain over several hours, and it did not improve. He was unable to sit up, roll over, or have any mobility at all. His neurology meant that he could not tell what was wrong, only that something was. He wasn’t even sure where the pain was located. He asked me to call an ambulance, and I did.
Once he got treatment in the ED, they began to talk about sending him home. I was very uncomfortable with this idea because he still couldn’t move. The providers weren’t even sure what the problem was because they had no experience with spinal cord injuries. They thought it might be some oddball muscle spasm that his weird neurology overreacted to. That’s very possible. It didn’t change the fact that he still could not move and they were standing around talking about sending him home.
Ultimately, it was decided to send him home via another ambulance. He was just as reliant on the ambulance crew going home as he had been going to the hospital. They had to put him in a specialized wheelchair to get him into the house and into his bed. They plopped him down and he still couldn’t move.
Now he gets the insurance determination and United says they won’t pay for the ride home because it wasn’t medically necessary. I’m wondering how anyone thought he could get home any other way. I had a car but there was no way I could have gotten him out of the car at home, and he probably would have slid down into the floor anyway.
This hospital is rural and has had budget cuts and doesn’t admit any patients unless they are cardiac patients. We did not know this when he was transported. There is another hospital a little further, so if he’d been admitted, he would have had another ambulance ride to get there. I think that’s important due to the insurance denial. They would have paid for that ride.
I have a lot of experience talking to United and I’ve offered to take this one on. I’ve not spoken to them yet. I’d like to know if anyone has any advice, knows of any laws or policies, or if there’s any particular language I should use…other than asking how a guy who can’t move gets home without an ambulance. It’s about a 3k bill, so no small potatoes.