In patient Hospital care denied. WHAT?

[DebV]

Hi everyone,  so I had my surgery 3 wks ago, a Middle Fossa Craniotomy on 9/07/16. I was in the hospital 5 days, I spent 24 hours in the ICU and was then taken to a private room where I would spend the next 4 days trying to recover my bearings that had just been scrambled by a 6 1/2 hour surgery. The balance nerves on my left side had been cut and removed during the surgery to remove my tumor. This means that the balance nerves on my right side have to learn to compensate for the left side now as well. This was and still is the most difficult part of my recovery. Although it's only been 3 wks,  im still adjusting to my balance issues and I haven't yet started driving again, but truly for the most part I'm getting better every day. And then I got the letter.  I received a letter today from my insurance company Aetna,  saying they have denied my Hospital stay past 3 days and will not pay for the last two days. SERIOUSLY?  HAS ANYONE HAD THIS HAPPEN TO THEM AND IF SO, WHAT DID YOU DO? I would appreciate any information. How ignorant was I to think my insurance would come through for me? 3 days hospital stay for Brain Surgery. REALLY?

Thanks,
Deb

[Kristena]

I had the same thing happen with a 6-day stay, but I think my doctor appealed and it was approved without my having to lift a finger. I think a 3-day stay is standard and the rest is automatically denied by your insurance company, then appealed, then approved.

[DebV]

Thanks Kristena, I hope that works out the same in my case.

[Highwireart]

I am an RN and have worked in utilization review. Call the insurance for an appeal or utilization review by an RN. Tell them you are appealing the claim and do so. Call the hospital's financial department. Ask for their review as well. There could be some errors in billing which might affect insurance. You can also, for curiosity sake, ask for a detailed bill from your hospital but they only give those out after you leave the hospital. Hopefully you will get this resolved. It could be that the tool they used to bill and reimbursed was entered incorrectly from an inexperienced nurse on the other end (behind the scenes stuff). Cheers!