My thinking comes from the thread linked above. Here it is:I highly doubt PT/OT or pain mgmt would be considered emergent care. Esp PT/OT which are all about recovery. Further imo those treatments should not be considered emergent. If the treatment not only can be deferred for two days but is being deferred, unless the doctor specifically orders no travel or only allows travel via medical transport, then imo you are choosing to have the procedure performed out of network.If you're going to an ICU, then there is no way you are being discharged and it is part of the same emergency. The issue arrises like the one linked higher up in this thread which I just got a chance to read. That poster's wife had a leg injury out of state that needed surgery. They were discharged and came back for surgery 2 days later. Since they were discharged the insurance company deemed the surgery 2 days later a non-emergency and now out of network. If they were admitted for pain control and Occupational/physical therapy eval and then received surgery it would have been one emergency visit.I think this is prudent advice.. I think the standard of discharge from the ER should be being able to go home, however I think the gray area here is if you're still unstable - are you still going to continue being in the ER, or shifted to a hospital ICU and then that stops being an emergency? The whole thing is ludicrous if you ask me and the law is very poorly written with loopholes the size of Texas.Emergencies are covered. If you are discharged from the emergency department you are best to travel back to your home state. From what I gather, if you are unable to get back to your home then your are not medically stable for discharge home and should contest being discharged with the hospital until you are stable to be discharged home that way it is all under one visit and one emergency. Talk the doctor involved in your care, I believe most would understand your predicament and try and get you admitted for pain control, Physical therapy / occupational therapy evaluation, or whatever is necessary for stabilization.
The law is not law, it is like the wild west out there in insurance land. They have all the power, they hold all the cards, and we are forced to play by their rules. It is a sad state of affairs.
viewtopic.php?t=379570
Synopsis: Person breaks their ankle. Goes to the ER, gets is splinted, needs surgery, but gets discharged for the swelling to go down and comes back 2 days later to get the needed procedure as planned by the orthopedic surgeon. Barely makes it to the hotel and in pain. She was physically unable to travel. They get billed out of network for the surgery and had to get lawyers involved to get it properly resolved. The whole thing took 2 years.
On the other hand if this person said they are unable to go home and refused to be discharged. They are in too much pain to go home and a risk for falls. They are unable to do activities of daily living. They can be admitted for pain control and potential eval by PT/OT. While inpatient, have the surgery, and then get discharged to actually go home in a now stable condition. All of that would have been considered in network since it was all part of the same ER visit. It also all depends on how the admitting physician documents their note.
Statistics: Posted by EnjoyIt — Wed Apr 10, 2024 2:51 pm — Replies 38 — Views 2168