One month in ICU, what happens if Insurance company rejects part of the billing?

Asked over 1 year ago - Seattle, WA

Patient currently on a ventilator but stable. Received a letter from insurance company saying coverage for some of the days was rejected. Then got another letter later saying they reviewed and now those days are covered again. Since the patient is still currently in ICU, we are really alarmed there will be a monster bill at the end of the day that will bankrupt the family. The delay to transition to a long-term acute care facility seems to have been mainly caused by a number of issues: 1. Insurance transition (Cobra ending end of month, then secondary becomes primary) 2. Major change in cost of ongoing medication (clinical trial kicked the patient out after learning about the ventilator, the commercial version costs $15,000 a month). Question is how to prepare for this and protect assets?

Attorney answers (3)

  1. David B Pittman

    Pro

    Contributor Level 20

    3

    Lawyers agree

    Answered . Try o make sure all treatments are pre authorized. Without knowing anything about your health insurance contract or coverages, it is impossible to give you advice on a forum. I would have an attorney look over the situation and advise you.

  2. Benjamin P. Cloward

    Contributor Level 10

    2

    Lawyers agree

    Answered . I am sorry to hear about this issue you are currently experiencing. I agree with the previous poster that you should consult someone in your area to discuss the matter.

    I would also talk to the hospital administration and determine whether they have a patient's rights advocate. Many hospitals have advocates who can assist with things of this nature.

  3. David J. McCormick

    Contributor Level 20

    1

    Lawyer agrees

    Answered . Sorry to hear about your situation. You could also try talking to the hospital’s social worker; they may be able to assist you.

    Good luck.

    DISCLAIMER: David J. McCormick is licensed to practice law in the State of Wisconsin and this answer is being... more

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