Last year at the age of 46 I suffered a minor heart attack

I worked out regularly before the attack and was in no major risk categories for the attack. After some tests (echo, heart cath) they determined there was no inherent heart disease and that I was probably suffering from viral myocarditis. I had been under alot of stress the previous months and getting run down due to over work. In fact the week before the attack I came down with shingles. I am fortunate that after 6 weeks of disability plus taking coreg and lisinopril my heart function returned to normal. I have not been on any medications since last summer and my last check up in January confirmed my heart function to be normal still. So I am extremely fortunate to have gone through this with no long term detriment to my heart.
Most of the bills were paid without problems and I don’t begrudge the co-pays I had to make given the total bill. However I have had problems with them paying the ER doctors bill. I went to an “in network” hospital but the doctor was not “in network”. They only paid about %25 of the doctors bill. I am sure it was due to coding problems because the explanation of benefits said basically the services for one charge were typically performed under another coded charge and they denied them.

I’ve gone round and round with the billing agency, the insurance company, etc. on this issue with no progress. I’ve appealed it once which was denied and plan to appeal it again. However I am trying to get better information for the next appeal.

I was wondering if anyone else has experienced problems like this and if so how you were able to resolve them (if you did successfully). I was trying to determine what might be typical (or as they say reasonable and customary) charges for and ER doctor providing approximately 1 to 1.5 hours of service for a patient suffering a heart attack.

I would appreciate any input anyone has on this subject. Thank you.

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