My own fight with appealing insurance
Picture this.
It's the middle of a Covid surge in South Florida, and hospitals and nursing homes are not allowing visitors. I get a call that my grandmother has fallen and broken her hip. She was admitted to a hospital, and underwent successful surgical repair. She got through a few post op complications and was working well with the therapy department.
Once she was medically optimized, I requested for my grandmother to be transferred to my acute rehab. To my horror, her insurance denied acute rehab, citing "medical necessity.” As you might have guessed, I was outraged, especially since her insurance was trying send her to a sub acute rehab, where she would not be allowed any visitors, and also receive less therapy and medical attention.
I wish I could say she was immediately transferred to my rehab. But sadly, the hospital kicked her to a nursing home before the appeal decision. Three days into her nursing home stay (during which time she received no rehab), the decision was overturned, and she was approved for acute rehab.
My grandmother was uprooted again, and transferred to my rehab. There, she got the care she deserved, and was successfully discharged home. Now, we would like to teach you how to advocate for what is best for you and or your family.
Step by step guide to appeal insurance denials
Try to stay calm and be nice. You will get the best results being friendly. Yes I know it is hard and not fair having to fight in this time of stress but you will need assistance from the hospital staff. Remember you get more bees with honey than with vinegar.
Follow up with your insurance company to confirm receipt of your appeal and to check on the status of the review process. Keep records, not only include a copy of what you sent, but also when you sent it and when it reached the insurance payer, any who you have talked to. The hospital may need to send in updated clinical notes the case manager or rehab coordinator should be able to assist.
Follow up with your insurance company to confirm receipt of your appeal and to check on the status of the review process. Keep records, not only include a copy of what you sent, but also when you sent it and when it reached the insurance payer, any who you have talked to. The hospital may need to send in updated clinical notes the case manager or rehab coordinator should be able to assist.
Follow up with your insurance company to confirm receipt of your appeal and to check on the status of the review process. Keep records, not only include a copy of what you sent, but also when you sent it and when it reached the insurance payer, any who you have talked to. The hospital may need to send in updated clinical notes the case manager or rehab coordinator should be able to assist.
How to format appeal letters
The header of the letter will vary by insurance.
It should include most of the following information:
-
Attention: Expedited Appeal
-
Reference #
-
[ Date ]
-
Re: [ Name of Person Whose Claim Was Denied ]
-
Insurance ID: [ Enter the insurance ID # for the person whose claim was denied ]
-
Date of Birth: [ Enter the birth date for the person whose claim was denied ]
-
Claim Number/Case ID : [ Provided by the Insurance ]