My question involves an injury that occurred in the state of Texas
My wife was involved in a car accident – she was hit head on while traveling through an intersection. Both auto’s were totaled, she sustained back, neck, knee, and abdominal pain. I took her to the hospital, she was x-rayed and examined, no obvious findings were noted, and she was told to give it a few days, and follow up if the pain persisted. More on this website
The other driver was ticketed, and found to be 100% at fault by his insurance company, they covered the loss of our car – at first at about 20% less that fair market value. I tore through the 3rd party valuation report and found a clunker being used in their valuation report that really lowered the value they offered. I brought it to their attention, and they came up with a much more reasonable figure. The property damage is resolved.
Nine days following the original accident, my wife continued to complain of very significant abdominal pain. Figuring enough time for generalized aches and pains to have passed, I was concerned. I contacted urgent care, and they suggested we get straight to the hospital, she could have a serious internal injury. I contacted my insurance carrier, told them what she was experiencing, and our medical claims adjuster suggested we seek appropriate treatment, and to visit the emergency room again if that was what urgent care suggested.
We did go to the emergency room again, she underwent a physical examination, and then a CatScan. The CT didn’t turn up any findings other than a slightly enlarged pancreas head, which was potentially indicative of pancreatitis, although the physician said it was probably nothing. Labs were run to ensure that it was nothing, and it wasn’t, her pancreas head is just a little bigger than “normal.” An incidental finding of the lab work was a minor bladder infection, which they physician said was in no way related to the pain she was experiencing. She was given a prescription for antibiotics for the infection, and told that the abdominal pain was likely the result from the force of the seatbelt – the location of the pain correlated perfectly with where the seatbelt lays on your body.
I received a notice from our insurance company that the bill for the second emergency room visit was denied, in full. The explanation given is that as the result of an independent medical evaluation, the services provided were not related to the motor vehicle accident. I have requested a copy of the report for review, and the bill has been submitted to my medical insurance carrier, the hospital has already indicated they find it likely the medical insurance will deny the bill and say its not related to the accident.
What are my options here? We went into the emergency room for abdominal pain that began immediately with the accident, and did not cease. Medical professionals and my insurance company both directed that it was important to go have my spouse examined because of the potential for serious consequences. Now they don’t want to cover the bill – I’m sure their report is going to suggest that the abdominal pain was somehow related to the incidental finding of a bladder infection – which is bogus, even the emergency room doctor told us flat out that wasn’t related in any way to the abdominal pain. Now, I could accept if they don’t want to cover the lab work for the pancreatitis testing – I wouldn’t have a problem paying for that. But the majority of the $2,300 bill is the radiology and the emergency room care – I don’t see what other “cause” than the auto accident prompted that visit, and why they shouldn’t pay. I didn’t want to involve an attorney, and I wasn’t considering seeking any kind of retribution or personal injury, but I’m worried now that if I don’t initiate some kind of action I may be stuck holding a bill that auto insurance and medical insurance are both going to say is the others responsibility.
I appreciate any advise, insight, options and idea’s you folks can offer. Thanks for your help. More Information here
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