UP FOR DEBATE

Soooooo….day care dropped ZGirl on her head.

For those of you who didn’t know that yet, I’ll provide details about it later (she’s fine but did end up with a nice shiner to match my avatar). Instead I want to ask your opinion about who should pay.

Well, besides ZGirl, who paid with seemingly endless tears and screams, the swelling of her eye to less than 50%, the abrasion from the carpet or the goose-egg on her head. Or of course, myself, who when she received the news via a phone call from the day care director, had the blood first drain from my head and then rush back up to it in fear and anger.

I’m talking money here.

I used to deal exclusively with no-fault insurance situations through my employer. I understand that most home-owners and almost all business carry it and why. However, I have decided to have the charges related to the ER visit (they charged us a level 5. I should be impressed since that’s usually for patients who have coded, lost a limb or need to be strapped to the bed with ankle and wrist cuffs), which will include a CT scan, sent to my own health insurance. I will then send the copay and/or deductible to the no-fault insurance at the daycare.

I made the mistake of mentioning this to someone who thought that since my employer pays for my health insurance (a portion. Not a majority, either), that I should send it to the no-risk first.

My reason to submit it the way I just mentioned is that I’ve seen similar instances where the no-risk is sent a claim, they pay, but the benefits get maxed (don’t forget I will have more than just an ER visit, but the ER physician and radiology physician to pay), and a balance is billed to the private insurance, who then apply the copay and/or deduc, leaving the poor policy owner/injured still having to pay out of pocket.

Some technical stuff to know: my health insurance is not Medicaid or Medicare which WOULD require by federal law for me to go through the no-risk insurance first.

What would YOU do? Yes, I really am interested in your opinion either way since nothing has been done yet.

(Tidbit of no purpose whatsoever:  did you know that there’s are codes for fall from commode, fall from other furniture, fall from wheelchair and even one for fall from cliff. A CLIFF! I’m not sure why that struck me as bizarre.)

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20 thoughts on “UP FOR DEBATE”

  1. I know this is REALLY late but I thought I would comment anyway.

    First, I am SO, SO glad ZGirl is ok. I got a huge lump in my throat when I read she’d been dropped.

    Second, and since I do medical billing for a living, I have to say that I would go through the no-fault first and this is my reasoning. Many times if you go through the private first and they find out a no-fault is also responsible they will ask for reimbursement and make huge headaches for you. Then after no-fault paid and private paid any over if there were anything at all above and beyond that I would ask that the daycare center pay it given that the incident was on their property. That of course is just my “two cents”. 🙂

  2. You know, I guess my followup question would be why should your insurance company take a ding for this? Typically, insurance companies have the right to recover money if an accident is somebody else’s fault, and this kind of WAS somebody’s fault, even if the extent of their ‘fault’ was they weren’t paying close enough attention.

    I’m not saying that we should hang your daycare from the yardarms, but they ARE liable, here, therefore…yeah.

  3. Oh my. The pictures tell the story, that’s for sure. I’d do whatever you feel is best as far as the insurance goes. There is already some good advice there.

  4. Like Aurelia, being Canadian I barely understood a WORD of what you said.

    Being a parent, I am suitably horrified that they DROPPED your baby!!!!

    wtf??!! Make em pay… literally!!

  5. Oh goodness! So sorry. No advice on insurance.

    As per your previous post, thank you for the instructions on the snow. However, as my blog is mostly white, it’s hardly showing up, which is too bad since it’s so fun.

  6. If my child jumped out of the chair and hit his head, I would pay but still be pissed that they didn’t watch him better.

    If they dropped him? They would pay.

  7. I agree with the ones above that suggested letting the insurance carriers work it out.

    (I also hope they were sufficiently mortified when they called you!)

  8. My favourite code in a hospital network I used to work in was, amongst all the other traumatic amputations needing treatment, ‘traumatic amputation, neck’.

    Clearly whoever was making up the codes just lsited every body part they could bring ot mind without thinking about it any further.

    J

  9. I just wanted to say on behalf of the Canadian single payer system, if you are ever wondering why your system costs more than ours, this is it.

    I literally do not understand what any of you have written.

    ??

  10. I’d do what you are planning on doing… bill my insurance and then bill the deductibe, copays, etc to the daycare… just my two cents of course.

  11. I’m leaning towards what ‘Jo’ said above, because that is indeed what their insurance is for and they’re required to have it.

    But I would also think long and hard about the future relationship I want with her daycare situation and whether or not they might invite you to leave in the near future for submitting the claim. Can you find affordable, equivalent or better care easily? If not, you might want to think on it.

  12. I chuckle every time I have to code a FOOSH. It just SOUNDS foolish, doesn’t it?? (For not-accident-prone people: A FOOSH is a Fall On Out Stretched Hand – it’s usually a fracture of the wrist)

    I’d do it your way, for the exact reasons you mentioned. Are you looking for a new daycare?

  13. If it works, what Jo said. Otherwise, no opinion…I would like take the path of least resistance but that is just because I am tired these days.

    I just wanted to express my shock and awe that a fall from a cliff happens often enough to warrant its own code. An impressive number of stupid or clumsy people out there.

  14. Your insurance company may ask if it was an accident and who was at fault. If you report that it occurred elsewhere, they will work directly with the other provider so you can step out of it. Which would probably be my recommended course of action.

  15. Me personally? I would pay my part and move on. Daycare takes care of your children and I wouldn’t want a bitter taste on their part, right or wrong. You are leaving them with your most precious commodity and if you love them and trust them, I say put this into having a child cost because it could have happened at home just as easy. If you think it was neglect then that’s a whole different can of worms. Good luck!

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