Insurance denied emergency transfer to out of state hospital; what happens if I just show up at their ER?
My 14-year-old son has been in and out of the hospital for the past 2 months with an extremely rare, life-threatening respiratory condition. There is one hospital about 250 miles from here in another state that has developed an intervention that can cure this condition. They have medically accepted my son as a patient; however, this week, despite many hours on the phone by doctors at this hospital and the one we want to transfer to, insurance denied the request for an air transfer to this other hospital. The doctors here have suggested something unorthodox to me, which is that we simply drive to the city where this hospital is, and when my son has a flare up of his condition, we go to their ER; however, I am terrified that our insurance company will consider this gaming the system and refuse to pay. At the same time, I am equally terrified of trying to manage this condition as an outpatient while we wait for a non-emergency referral to work its way through the system.
My plan is supposed to cover emergency care, but are there caveats to this?
submitted by /u/scientrix
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