Following surgery the individual was moved to a rehab hospital where her condition deteriorated. She was moved to the ICU of the original hospital. The insurance company wants to move her to a lesser care facility without resolving her health issues. What can her family do to dispute/block her moving?
2006-07-31 14:50:56 · 10 answers · asked by storm 2 in Health ➔ General Health Care ➔ Other - General Health Care
Write an appeal letter here's a link to a site (the CT office of health care advocate) I guess you state may have a similar site?
Document EVERYTHING, tape every phone call, conversaion with the insurance company. they play dumb., when it comes to handing out money. best of luck.
http://www.ct.gov/oha/cwp/view.asp?a=2265&q=299856
2006-07-31 15:01:51 · answer #1 · answered by Patrick Bateman 3 · 1⤊ 1⤋
Check your insurance policy. Not trying to be the bearer of bad news, but the insurance company is only going to pay for what is agreed upon in the policy. They are not necessarily questioning medical necessity. I'll pick on Dental insurance for an analogy. You have a cavity and need a filling on a molar. Your DDS only does composites (white) fillings, even on posterior (back) teeth. Your policy most likely will only cover the cost of amalgams (silver) fillings on back teeth. So although the filling is necessary, you can have the white filling, but you will pay the cost difference between the white and silver filling. I hope that makes sense.
If the policy will only cover the allowable cost of a lower care facility, see if they will apply that amount to the cost of the facility recommended by the doctor. In other words if the facility they want and will pay for $500 a day (I dont know what it costs) and the one you want costs $750, see if they will apply the $500 to the $750 bill. It's not much, but it will help.
If this is an individual medical policy, your agent should be able to explain the specific benefits around this issue. However, you will need an attorney to help you completely understand your rights and file any complaints. If it's a group policy through an employer, contact your Human Resources department or the Benefit Administrator. They will be able to help you understand the benefits covered by the plan and what options you may have.
A side note: If the Benefit Administrator or HR agrees to call the insurance company on your behalf make sure you are available. If your employer has not filed a HIPAA certification with the insurance carrier, you will need to give permission for them to assist you. Typically a carrier will take permission from you over the phone after asking a few identifying questions. You can then turn the phone over to the BA or HR rep. Or the carrier may fax you out a form to complete, sign and fax back. Either way, the more accessible you are, the quicker you will be able to get things moving.
2006-07-31 22:13:42 · answer #2 · answered by Karen T 3 · 0⤊ 0⤋
State Insurance Commissioner. State Senator.
Mayor. Lawyer.
2006-07-31 21:54:43 · answer #3 · answered by helixburger 6 · 0⤊ 0⤋
Most insurance companies have an Appeal process. Some have a nurse liasion you can talk to about the care being given.
2006-07-31 21:55:35 · answer #4 · answered by RSPKR 3 · 0⤊ 0⤋
Have you tried writing an appeal to the insurance company? Or having the patient's doctor write an appeal? I used to work in medical billing and that sometimes works.
2006-07-31 21:54:40 · answer #5 · answered by arun 3 · 0⤊ 0⤋
Have you tried writing an appeal to the insurance company? Or having the patient's doctor write an appeal? I used to work in medical billing and that sometimes works.
2006-07-31 21:53:32 · answer #6 · answered by telaine 3 · 0⤊ 0⤋
Appeal to the insurance company. If that doesn't work, complain to your state's department of insurance - it's a highly regulated industry, and a letter from the department of insurance is the last thing they want.
2006-07-31 21:54:51 · answer #7 · answered by nkasoff 3 · 0⤊ 0⤋
call the insurance company and find out who needs to be contacted, then talk to that person about what you need to do to prove she needs the care she is currently getting.. but be sure to check the fine print on your policy to see if you are limited in your care rights in any way. A lot of times your Dr writing a proper referral is all you need.
2006-07-31 22:03:58 · answer #8 · answered by mrs.moogie 2 · 0⤊ 0⤋
I had this problem....... Insurance companies are crooks.
Keep her where you want to keep her. Get an Attorney that will take your case and you don't have to pay him until the case is resolved.
Sue them............... That's what I had to do.
2006-07-31 21:59:46 · answer #9 · answered by Anonymous · 0⤊ 0⤋
get a lawyer
2006-07-31 21:55:12 · answer #10 · answered by Anonymous · 0⤊ 0⤋