Venting.

[judiz]

Received a phone call from the doctor today, the insurance company notified her that they will not pay for my husband's care any longer. She spent 45 minutes on the phone with them and managed to get one additional week approved. Not sure the reasoning behind and not sure what my next move should be. Do I file an appeal or is that the hospital's responsibility? In the meantime, Boston requested more information from the doctor before they approve his admission, date still unknown.

 

[Vagabond]

Received a phone call from the doctor today, the insurance company notified her that they will not pay for my husband's care any longer. She spent 45 minutes on the phone with them and managed to get one additional week approved. Not sure the reasoning behind and not sure what my next move should be. Do I file an appeal or is that the hospital's responsibility? In the meantime, Boston requested more information from the doctor before they approve his admission, date still unknown.

(((((judiz & husband)))))

I'm pretty sure that you are the one who needs to do the appeal, since your husband is the insured and you are his next-of-kin. I'd suggest calling the insurer and asking how to handle the appeal.

 

[Buzz]

I am so sorry @judiz.

 

[AxelAnnie]

Man! So sorry. You get on the phone and start screaming at people at the insurance company. The hospital can help, but you have to do it. And remember, (unfortunately) the squeaky wheel gets the grease.

Kaiser turned my uncle down for a stent...........said it didn't pan out financially since it only lasted 5 years. So, that was 18 years ago, and several shouting matches later! As I said before, my sister is very good at getting medical people to stop their nonsense.

Good luck.

 

[Vash01]

(((Judiz)))

I don't know what to say. I wonder if there may be a legal avenue? I have no experience in this area but I hope good things come your way. Hang in there.

 

[skatesindreams]

Man! So sorry. You get on the phone and start screaming at people at the insurance company. The hospital can help, but you have to do it. And remember, (unfortunately) the squeaky wheel gets the grease.

You need to ask if they want to be held responsible for whatever happens, should he not receive continuing treatment!
I believe you need to seek legal counsel, to make this stick.

 

[Spun Silver]

It just doesn't stop. Sorry and good luck with the insurance company. I would talk to them at length before hiring a lawyer. It's puzzling. Our insurance has covered almost everything without question, and I'm talking hundreds of thousands of dollars in hospital/medical bills in a single year. Are mental health issues so different? Is it a terrible insurance plan?

 

[Impromptu]

The hospital might be able to help you with letters of medical necessity - they should have a patient financial representative available to give you guidance - but you would need to file the claim yourself. Some hospitals may also have a legal aid set up for these situations (again, ask the patient financial representative).

Depending on the department and illness, they might be used to dealing with these situations (I work alongside the bone marrow transplant department, and they run into things like this a lot, especially with certain insurance companies -- in one situation, I remember that the patient ended up turning to local news to help gain attention - and his doctors here were more than happy to support the publicity campaign).

 

[attyfan]

Call your local bar association/lawyer referral service ASAP and get a referral to a lawyer who deals with the specific insurer, if possible. If not, you want an attorney who handles ERISA cases (if it is employer provided health insurance); if not employer provided insurance, you want someone who does insurance bad faith. Or, NAMI or similar mental health group may know of attorneys with experience in this problem.

 

[Cachoo]

attyfan, you sound like you've been through this before or know someone who has...I love FSU for posts like yours. Hang in there judiz.

 

[Aceon6]

@judiz You can call your state's insurance commission for help. The number should be on you insurer's website in the section that talks about appeals. And talk to the hospital's financial assistance people. They know a lot about resources that might be available to you.

 

[Aussie Willy]

Very sorry to hear about your troubles Judiz. That absolutely sucks. I am so glad I live in a country where we are covered for medical treatment without question (having just been through it).

Good luck with it.

 

[quartz]

Oh no! ((((((judiz)))) I can't believe you now have to fight with your insurance company on top of everything else.
I hope the suggestions made by others here will help quickly with your issues.

 

[clairecloutier]

I can only echo what everyone else has said, @judiz .... So sorry you have to deal with this insurance issue, and good luck with it. Prepare to spend a lot of time on the phone.... I'm dealing with some insurance issues myself now, and it just takes forever to straighten things out it seems.

 

[millyskate]

((Judiz))

 

[Coco]

@judiz You can call your state's insurance commission for help. The number should be on you insurer's website in the section that talks about appeals. And talk to the hospital's financial assistance people. They know a lot about resources that might be available to you.

I would like to second this recommendation, in addition to the other suggestions here. But this should be a helpful early stop in this process.

I'm so sorry you are both going through this and I think of you and your family every day.

 

[judiz]

Spoke to the insurance company, not sure where the misunderstanding happened but, my husband can remain in the hospital as long as the doctor can submit clinical proof it is medically necessary for him to remain an inpatient.

 

[Buzz]

Wonderful news @judiz!!!

 

[AxelAnnie]

Spoke to the insurance company, not sure where the misunderstanding happened but, my husband can remain in the hospital as long as the doctor can submit clinical proof it is medically necessary for him to remain an inpatient.

YAY! Probably a syncing issue.....insurance coverage needed to be re-upped, amended, or re-submitted, and the DR was a bit out of sync with the process.

I am so happy. Good luck, and just keep on truckin!

 

[quartz]

That must be a huge relief. I hope you are getting the occasional break from this relentless situation.

 

[BittyBug]

@judiz I am so sorry that your anguish is being compounded by bureaucratic issues. I hope the hospital in Boston will have space for him soon, and that your insurance coverage will continue unquestioned. ((((((hugs))))))

 

[Japanfan]

I'm happy for you that the issue was resolved, Judiz, though sorry you had to go through all that stress.

My initial response was identical to Aussie Willy's - gratitude that I live in a country with public healthcare, even though Canada's system is not without its problems.

When I hear what Americans have to go through with healthcare, it boggles my mind. On top of having to cope with a series illness and perhaps surgery and hospitalization, so many Americans have to go through all this red tape and fight with insurers who seem to care only about the bottom line. That would all be very disheartening and the added stress would drain away energy needed for a person to deal with health issue. Potentially it could make the health issue even worse. For example, there is a strong mental aspect to dealing with cancer. It would be hard to maintain a positive attitude if a person with a cancer or that person's family member didn't even know whether treatment would be covered.

 

[skatesindreams]

That must be a huge relief. I hope you are getting the occasional break from this relentless situation.

This!

Please, continue to vent whenever you need to.
We are here to support you.

 

[judiz]

Now the insurance company is ready to help with the cost of a hospital in Wisconsin but won't commit to the one in Boston. We live in New Jersey.

 

[Buzz]

(((((@judiz & husband )))))

 

[skatesindreams]

On what basis do they justify that?
Is the hospital in Wisconsin better in some way?

 

[Rob]

What are they saying -- that they will pay the amount that is charged by the hospital in Wisconsin even if you are in Boston? Or that they think the Wisconsin hospital is adequate for his needs and won't pay for Boston at all?

You should request a copy of the full plan (if an employer plan) or policy (if insured). They should provide you with citations to the plan or policy provisions they are relying on. This is worth consulting with a lawyer.

 

[AxelAnnie]

Geesh! It would probably help if you can get a DR. to certify that the care he needs he can get only in Boston. Although, summer could be nice in Wisconsin.

 

[judiz]

Meeting with doctor and social worker tomorrow to get progress report and more information about the insurance company and hospital for further treatment.

 

[gkelly]

Hoping the meeting will get everyone working together toward the same goal (your husband's health)!