My health insurance through my work states in my insurance outline that certain procedures and services are covered 100% - such as ambulance rides, teeth cleaning/full mouth xrays. But now I'm being charged -- for example my ambulance ride I'm being charged 900 dollars as they say the ambulance companies charges are excessive so they will not cover it. How do they get to just choose which they pay and what they won't when they state to cover 100%. I've talked to everyone I can and my insurance company won't budge. Is there anything I can do about this??

Welcome to the world of endless denials.

That is the problem with health care for profit.

You can fight it, but where do you go? A lawyer? A government agency? The insurance company that has a vested interest to say no?

We need universal health care, PERIOD

I don't give a rats behind what the "personal responsibility" crowd say, the fact of the matter, this whole health insurance and health system is NOT HEALTHY FOR OUR COUNTRY, OR YOU AND ME, OR YOUR UNCLES, AUNTS, MOTHER, FATHER, BROTHER, SISTER, YOUR BOSS, HIS BOSS, YOUR CO WORKERS, OR ANYONE LIVING IN THIS COUNTRY.

I wish you one size fits all personal responsibility nuts would understand, that $hti happens and people who are very very responsible end up on the losing end -- and in so many cases end up losing everything they have spent a lifetime acquiring in a few short months of a catastrophic illness or injury because lifetime benefits ran out.

Here is another tid bit to think about -- we have universal health care in this country now. Our military and here is the real kicker, our federal leaders get to enjoy the best of what the military has at the Bethesda Naval Hospital and Walter Reed Army Hospital while they underfund the rest. Which of course makes everyone believe Universal Health Care will not work in this country.

Finally, we are occupying two countries and WE PROVIDE UNIVERSAL HEALTH CARE TO THEM.
Why is it that we provide Universal Health Care to them, BUT NOT OUR OWN PEOPLE?

All I have to say to that is BULLLLCHITT!

Peace

Jim

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Most coverage pays 100% in case of emergencies, so you might want to try that angle.

Other than that, you might go back to the ambulance service and ask them to adjust their pricing. The reason the insurance company is not covering the excess charges is because they are beyond what is considered 'usual and customary' in your area, which means that the ambulance service is charging you an inflated rate. Sometimes when you contact them IN WRITING about their excessive costs and taking advantage of people in emergency situations, they will lower or write off your balance to avoid the negative documentation.

Or you can file an appeal with the insurance company and request how their calculated the reasonable and customary rate for your local area. Your employer be of some assistance in that process.

is the medical provider a "network" provider

THat only applies to network providers, all others are billed differently. in those instances they do get to choose what they pay.

Also the 100% can also mean like (after a 1000 dollar deductible)