Just Another Jen Posted July 25, 2014 Share Posted July 25, 2014 We got a letter yesterday saying that our health insurance would not be paying for our oldest sons hospital stay. 6 days in the icu. Reason- it is unclear that it was medically necessary. I can see their point, there are so many people in the icu who don't belong there.- not. Its always something. Quote Link to comment Share on other sites More sharing options...
idnib Posted July 25, 2014 Share Posted July 25, 2014 Wow, based on your earlier description of hat happened I don't see how it could have been anything but the ICU. What's the next step? Quote Link to comment Share on other sites More sharing options...
Just Another Jen Posted July 25, 2014 Author Share Posted July 25, 2014 There were instructions on how to start the appeal process. I am going to call an attorney tomorrow also. Quote Link to comment Share on other sites More sharing options...
idnib Posted July 25, 2014 Share Posted July 25, 2014 There were instructions on how to start the appeal process. I am going to call an attorney tomorrow also. That's good. I'm :banghead: for you. Quote Link to comment Share on other sites More sharing options...
Word Nerd Posted July 25, 2014 Share Posted July 25, 2014 Oh, my! Sorry you have to deal with this mess after so much stress already. Quote Link to comment Share on other sites More sharing options...
TechWife Posted July 25, 2014 Share Posted July 25, 2014 It is quite possible that the bill was sent without any medical records, or without the records that they want to see. Call the insurance company and ask them what they need, then call the hospital and have them send it. It really could be that simple. I know how you feel - my son was in PICU for six days back in January. Due to the way the holidays and weekend fell, his stay wasn't "pre-authorized" until the day we checked out of the hospital. There is still a surgery charge outstanding that is on appeal. My stack of hospital & doctor bills and insurance papers measures just over one inch thick. I hate to say it, but you might be in for a long haul with it. Quote Link to comment Share on other sites More sharing options...
creekland Posted July 25, 2014 Share Posted July 25, 2014 :grouphug: :mad: :banghead: :grouphug: May your appeal be successful and really sorry to hear you're having to do it. Quote Link to comment Share on other sites More sharing options...
QueenCat Posted July 25, 2014 Share Posted July 25, 2014 Sometimes it really is just a matter of the hospital not having coded things properly the first time. Call the hospital, and ask them to double check their coding. Quote Link to comment Share on other sites More sharing options...
Annie G Posted July 25, 2014 Share Posted July 25, 2014 That's crazy. Hope you get it sorted out quickly. I can't imagine once they see the details that they will continue to deny it. When dh had his heart attack, our local hospital sent him in an ambulance to a larger hospital because he needed an invasive procedure that our tiny hospital couldn't do. The insurance paid every bit of the bill EXCEPT the $50 cost for cardiac monitoring on the ambulance. He was having a heart attack and cardiac monitoring wasn't deemed necessary. Crazy, huh? Quote Link to comment Share on other sites More sharing options...
creekland Posted July 25, 2014 Share Posted July 25, 2014 He was having a heart attack and cardiac monitoring wasn't deemed necessary. Crazy, huh? I guess the theory is that if they already know he's having a heart attack they don't have to keep checking to see if he still is? :lol: In reality... :banghead: Quote Link to comment Share on other sites More sharing options...
Word Nerd Posted July 25, 2014 Share Posted July 25, 2014 Maybe the hospital didn't provide all of what they needed or the correct information? Quote Link to comment Share on other sites More sharing options...
SJ. Posted July 25, 2014 Share Posted July 25, 2014 I would call the insurance company to determine the problem. I have had some problems with coverage being denied this year and every time a few phone calls clear everything up. Quote Link to comment Share on other sites More sharing options...
NoPlaceLikeHome Posted July 25, 2014 Share Posted July 25, 2014 There were instructions on how to start the appeal process. I am going to call an attorney tomorrow also. 8 years ago our insurance tried to deny an ER visit for my child who had a stiff neck, neck pain, and was inconsolable for over an hour which are all red flags of serious problems. I knew this as a nurse. I wrote up a letter of appeal and won. 12 years ago my insurance tried to deny payment for meds for medically necessary induction of labor! Again 10 phone calls and finally they covered. Insurance companies love to deny coverage and I think they count on people just accepting denial of coverage. Before you call an attorney, I would try getting your doctor to help with the appeal process. Quote Link to comment Share on other sites More sharing options...
LostSurprise Posted July 25, 2014 Share Posted July 25, 2014 Ahhhhhh insurance! I remember being on the phone for hours a day last year because our insurance wouldn't cover the PT/OT our orthopedist ordered because ds is diagnosed as developmental disability. I guess that's not a real diagnosis. The background on hold was a constant reminder to get checked for chlamydia. Hours of chlamydia reminders. I guess we all really, really, really need to be checked for chlamydia. In other news, I didn't realize it was possible to miss muzak. This year, dh's work changed insurances last month. They gave us 2 weeks notice. We found out because our previous insurance notified us (not the company). When I tried to order ds's g-tube stuff and special diet formula we were told they needed 7-12 days to process our request. 7-12 days to find out if ds is allowed to eat told to me when we have 2 days of formula left. Yeah, thanks. At least everyone tried to get that all worked out. No one wanted to leave a kid without food so they decided to process the request in 48 hours. When I called dh's HR dept. they asked me why I didn't get it pre-approved. :rolleyes: I guess this is all my fault. Even though I still have no benefits paperwork. They approved the equipment but denied the formula, so I'm making my own formula using an online calculator while we go through the appeals process. I can't use the equipment because you can only use it with the formula. :willy_nilly: I've done what I can do. I've decided to pretend nothing is wrong for the weekend and sleep as much as possible. Quote Link to comment Share on other sites More sharing options...
Susan C. Posted July 25, 2014 Share Posted July 25, 2014 I'm a veteran of getting insurance to pay denied claims.... but have "won" every time. Write that appeal letter, then just check in regularly. They are on their own time schedule. And the State Board of Insurance (at your state's capital) is your friend. If the hospital didn't get authorization to keep him in ICU, then one of two things needs to happen: 1) the hospital needs to do the leg work of showing it was necessary to get paid, or 2) write it off. Quote Link to comment Share on other sites More sharing options...
Pawz4me Posted July 25, 2014 Share Posted July 25, 2014 I wouldn't call an attorney. Appeals are pretty routine. Tedious and irritating, but routine. Quote Link to comment Share on other sites More sharing options...
Twigs Posted July 25, 2014 Share Posted July 25, 2014 :grouphug: :grouphug: :grouphug: Quote Link to comment Share on other sites More sharing options...
Word Nerd Posted July 25, 2014 Share Posted July 25, 2014 I would call the insurance company to determine the problem. I have had some problems with coverage being denied this year and every time a few phone calls clear everything up. I've had to make a couple of appeals and easily cleared the problems up both times—once by writing a letter and sending a copy of documentation, and once by calling. I wouldn't contact a lawyer unless necessary. Quote Link to comment Share on other sites More sharing options...
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