Any idea why United Healthcare/Medicare would deny paying for an ER visit for my 90 year old mother with a 107° temperature?

You are not responsible for your mother’s hospital bill. There is not much the hospital can do but write it off since Mom doesn’t have the resources to pay it. Do Not agree to pay the bill!

I know in this instance this was an emergency. But we all need to know how we and our parents are covered insurance wise.

If you can tell us what kind if insurance Mother has, it would help in getting the correct answers on how to help you proceed.
Mom either has Straight Medicare with a supplimental, Medicare with Medicaid, or a Medicare Advantage. In my opinion, if Mom was in the hospital for 2 days, admitting should have informed someone that the insurance would not be paying for her care if they did not except it so it would be private pay. Or she could be transferred to a hospital that excepts it.

Medicare Advantages are hard to work with that is why at 73 I will not have one. I have done well with Medicare and Blue Cross. I am not going to now be on the telelphone arguing with someone over a bill they should pay. You are talking to someone who is reading from a book probably.

Even on Medicare, there are facilities and doctors that don't take it and Medicaid limits you even more. Usually straight Medicare with a suppliment the suppliment usually pays whatever Medicare allows.

You Moms NH should have it on file what Hospitals Mom can be transferred to. This info would then be been given to the EMTs and they would have to take Mom to that Hospital.

We learn by hit and miss. Me, it was Mom being taken to the ER by ambulance. When she was discharged at 11pm, we were told it was going to take another hour to get a transport. We opted to drive her back and nobody said anything. We get back to the home and they will not allow her in without being transported. Back to the hospital, because she was discharged, we were not allowed back in ER but a nurse said she would call for transport. We waited...then the nurse came out and said the NH was allowing us to bring Mom back. We were told that the Supervisor was called and agreeded to let us return her but this was not normal procedure.

Is this an Advantage plan?

If yes, you need to contact United Health care.

If no, you need to contact Medicare. Because your supplemental insurance follows Medicares decision and pays if they do.

My dad had a united health care supplemental plan and they always paid if Medicare did. They were awesome to deal with but, my mom has an Advantage plan and is always complaining about what they don't pay.

It all depends on if Mom has straight Medicare and a supplimental or this is a Medicare Advantage.

Medicare contracts out to these advantage plans. They are suppose to cover Medicare part A & B. They do have networks that you you have to stay within. I would call and talk to a supervisor, not someone who answers the phone. If you can't get anywhere, then let the debt go. You are not responsible for Moms debts.

Go to their website and see what Providers are and aren't covered by them, or you could go to your states Medicaid Website and also search (if she is on Medicaid). You may be surprised at hospitals that are and aren't covered under these various Insurances.

MyMom had United Healthcare supplement. Excellent service. They declined one charge. I called and explained what happened and they paid immediately. Local EMT service took her to an ER that wasn’t where she usually went. There had been a large car wreck and usual ER was full.

I believe with United Healthcare there are various differant contracts. Example, the United Healthcare that my sig-other has, from where he had retired, he has a co-pay to see his primary doctor. I have AARP United Healthcare, and there is no co-pay to see the see the same doctor.

We have been quite pleased with that health insurance company.

United Health Care is notorious for deny bills for all manner of reasons, in hope you will just pay it....or ask hospital for a payment plan and leave United out of it completely. Do appeal, and contact the billing office at Mayo to explain why you needed medical documentation. Ask for the name of the person that helps you, and follow up with a written letter or email confirming what was discussed in the call. A large medical center like Mayo must deal with this all the time...so there are people familiar with the sorts of information that is needed to support the claim, and they know how to revise the claim if it was not accurately coded the first time. Insurance companies don't want to pay claims if they can come up with a reason to deny them...and often they know the service is covered but they are going to delay the time that they have to part with their money.
Most of the work in an appeal has to be done by the patient and provider, not the insurance company.
United Health care should have already provided her with a written copy of the appeals process including deadlines, so did that out.They get to choose the rules, at least to start.
No insurance company wants to pay claims, no matter what their marketing campaigns may promise.

She was on Hospice at the time of this emergency?

That may be the reason for the denial; once on Hospice, you need to contact Hospice to discontinue their care before calling 911.

Hospice should have explained that to you.

Or do you mean that she in on Hospice subsequent to that emergency hospitalization.

In any event, I would appeal. Claim ignorance if you need to.

She is self pay. Her ability to pay/funds are nearly gone. She is on hospice now and not sure she will make it another month. She lost the ability to stand/walk after the temp spike and we started hospice. She is also at the end of the dementia road.
I'm just shocked to get a letter declining her emergency care. I will file an appeal. Thank you everyone that responded.

Fight it . Do not pay. How is it that she’s on Medicare & supplement after 2 1/2 years? Wouldn’t it be Medicaid? My mother was just in nursing home..S/T rehab…& then after 5 weeks they decided she’s not progressing…say you don’t have the $$$ ..Hugs 🤗

Is Mom private pay or on Medicaid? Makes a difference in how you are paid.

Medicare Advantages work lots different than straight Medicare and a supplimental. Same with Medicare with Medicaid.

I agree with Barb, call the hospital. It could be as simple as the hospital administration putting down the wrong medical billing code, which is a fairly simple fix.

My daughter just had shoulder surgery in June, and I got a statement from the anesthesiologist that the anesthesia part of the claim was denied, due to not being pre-approved. I called up the office and told them they wouldn't have DONE the surgery unless it had been preapproved. Oh, oops, we put down the wrong code, we'll re-submit. Viola, it got paid!

Sometimes I think they're trying to get one over on people, if they send out enough of these "bills" and even 1% pay, they've made money over and above what insurance pays out. Some people panic and pay it before they even question it, especially if it's not an insurmountable cost (a few hundred dollars, say).

I have a great friend whose MIL worked doing medical coding for an insurance company, she told my friend never, ever pay a medical bill from a hospital or a doctor's office (beyond your expected co-pay) on first notice. If they believe you really owe it, they'll send a second notice; then call the office and question why you received the bill.

That said, this is mom's bill to pay, not yours.

Good luck.

Your mother has been living in a nursing home for more than two years. Unless she is super wealthy and you're paying for her stay out-of-pocket or she had LTC coverage, she's on Medicaid.
You are not responsible for paying any of her medical bills.
The only way that you can be hed responsible for her bills is if you ever signed any paperwork with the nursing home agreeing to it.
Even if you did, only the nursing home could hold you responsible. Not any other institution if you signed an agreement with the nursing home.
They're just trying to shake you down to get paid. You don't owe them anything. It's a shakedown. Just ignore them. If they harass you too much, let them take it to court. It's not worth their time for 15 thousand dollars.

Because you're not already stressed out enough after having to deal with your mother's temperature of 107 and spending 2 nights in the hospital as a result, huh? UGH I HATE INSURANCE COMPANIES WITH EVERY OUNCE OF MY BEING.

I hope you win the appeal and another $10K for the pain and suffering the aholes are causing you for all this meshugas.

We have Kaiser insurance and can only go to their hospital BUT in the case of an emergency, we can go anywhere for treatment and they WILL pay the bill simply b/c it's an emergency. And for Kaiser to have that caveat in place means ALL insurance companies should have such a caveat in place. Your mother had a life threatening emergency going on with a fever of 107 and was taken to the closest ER which was the right thing to do.

No, this is not your bill to pay but it IS your aggravation to deal with. Best of luck with the appeal process.

This is your mother's bill, not yours.

Follow the instructions for how to appeal.

Call the hospital and tell them about the denial and ask for support of the appeal.