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Two Days From Surgery And Insurance Refuses

Just found out insurance is refusing to approve his treatment again. NEVER get an HMO. They're saying they approved the doctor and the hospital, not robotic surgery. We had a huge fight to get it to the teaching hospital. They KNEW we were asking for robotic surgery. It was the REASON we were able to get the referral .... my hospital has a medical deficiency -- no robotic surgery -- so they allowed us to go out of network. Now they're saying NO to the robotic surgery two days before surgery. I'm grateful my daughter is a lawyer. We've already called and left a message for someone to call back. I do believe in prayer and I've seen my Lord work miracles before. I'm asking for one again.
*** UPDATE *** They approved him for the surgery and for staying at hospital day of surgery only. We're goingfight it and try to get them to extend it to the three days the surgeon asked for. I'm grateful for the approval.
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I spent only a single night...
Very possible that he's able to go within 24 hrs. Trust me, you don't want to be in the hospital. Hospitals make people sick... Get out of there as soon as possible. He'll heal much better and faster at home.
It's very similar to having your tonsils out...shouldn't be more than a day... Everyone is different though.
Good luck.
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Which HMO are you using? I'm
Which HMO are you using? I'm with Kaiser-Colorado and get excellent care. They have decoupled the medical providers from the administrators. If you have a lead medical provider I would work thru them and their team. It's risky for an administrator to say No to a doctor. I ask for nothing from the admin side of Kaiser, I just let my docs order stuff. If a doc deems it within the Standard of Care and the admin side pushes back, the admin side assumes liability.
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If the Carrier (Insurance)
If the Carrier (Insurance) denied past the initial 24 hours as not medically necessary, the Hospital (Provider) can do a L1 appeal. If the carrier denies (upholds denial) the hospital can issue a L2 appeal, submission of medical records and itemized statement. Sometimes that involves a peer-to-peer physician meeting over the phone. Either way the patient is never on the hook for medical necessity denials. The hospital either gets the denial overturned or they write off the costs. My company does denial management for several large teaching institutions.
Mojo sent for a good recovery ----------------->
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Thank you for the info,hlrowe said:If the Carrier (Insurance)
If the Carrier (Insurance) denied past the initial 24 hours as not medically necessary, the Hospital (Provider) can do a L1 appeal. If the carrier denies (upholds denial) the hospital can issue a L2 appeal, submission of medical records and itemized statement. Sometimes that involves a peer-to-peer physician meeting over the phone. Either way the patient is never on the hook for medical necessity denials. The hospital either gets the denial overturned or they write off the costs. My company does denial management for several large teaching institutions.
Mojo sent for a good recovery ----------------->
Thank you for the info, HLrowe. That will help me with anything down the road.
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