Letter of Denial of Service to my son???

[missmel3315]

Ok Blue help me figure this one out. When oldest son was in the short term psychiatric facility we had our first/last/and only family planning meeting which at that time we told them he was set to go to NC on May 5th and that the doctor said that they were still doing the testing. Which is why they didnt go over the results with us that day. Said they wouldnt be ready for a day or so. Ok so the plan is he will be released on the 4th which will give them time to finish their assessments ect per what our psychiatrist said. Then I go later that evening for our visit with my son only to be told that he had been discharged . I had a fit and asked who discharged him as it wasnt told to us at the time of the family meeting which was held just four hours before. Nor did they call and at least tell me what was going on. They recinded the order and kept him for an additional day when we went and picked him up as they said our INS would probably not pay now.

Here is my question. Today I got a letter in the mail addressed to my son, not us, stating that his appeal was denied...I don't remember filing an appeal in the first place. Secondly how can they send this to him as he isn't the insured. husband is. I am not sure what to do about this as we will be changing insurance at the first of the month and it isn't addressed to us. Any ideas??

 

[bigblueagain]

Mel sorry so late in seeing this. But I am going to assume the denial letter is for the last day of the hospitalization, when he was already discharged, but then kept for the overnight to finish testing. Most insurance carriers look at testing as something that can be done on an outpatient basis. If he was no longer a danger to himself or your family then the appeal will be difficult to get. There should be a telephone number and/or address to which you can call and ask what it means and how to go further. Alot of times the facility will initiate the first appeal as they are the ones who are ultimately out the money as they know you probably will not be able to pay them. That is why you probably were not aware of it being submitted to start with. As to it being addressed to your son, not you, that is usually because theyare submitted in the name of the patient not the insured. What type of coverage are you going to at the beginning of July by the way? Do you know what type mental/nervous coverage you will have with the new carrier? BLUE

 

[bigblueagain]

Mel sorry so late in seeing this. But I am going to assume the denial letter is for the last day of the hospitalization, when he was already discharged, but then kept for the overnight to finish testing. Most insurance carriers look at testing as something that can be done on an outpatient basis. Especially since the Difficult Child order was already written. If he was no longer a danger to himself or your family then the appeal will be difficult to get. There should be a telephone number and/or address to which you can call and ask what it means and how to go further. Alot of times the facility will initiate the first appeal as they are the ones who are ultimately out the money as they know you probably will not be able to pay them. That is why you probably were not aware of it being submitted to start with. As to it being addressed to your son, not you, that is usually because theyare submitted in the name of the patient not the insured. What type of coverage are you going to at the beginning of July by the way? Do you know what type mental/nervous coverage you will have with the new carrier? BLUE

 

[missmel3315]

Thanks for the info LMS and Blue. I have 360 days to appeal this letter as yes you are correct that it is for the last day of stay. Although I got an EOB from the insurance company the other day and while it stated that they denied the last day of coverage to the tune of 800 dollars it stated that the patient portion was zero dollars. I am going to keep that in case anyone gives me trouble.

As for the new insurance I am glad you asked as it is something I have never heard of before it is called Aetna(which I kno) EPO. This is supposed to be exactly like an HMO from what I am told and what I have read but nobody has ever heard of it before. Everything is the same as far as our benefits with Cigna so I am hopeful that it is an ok plan. The only downer is that our psychiatrist is not on it. Although he wasn't on our plan with Cigna and we were able to get ADHOC services as we live over 50 miles from Corpus Christi where all their contract docs are. Hopefully we can do the same with the new insurance. If you have any info on EPO's I would be interested in learning about it.

Thanks in advance

HUGS

 

[susiestar]

So sorry you are getting Aetna!! I had fits with getting them to pay ANYTHING! It took 4 years of fighting to get them to pay for my pcdau's birth!!!! And yes, I was fully entitled to maternity benes. They refused to acknowledge that they received paperwork on her. My keeping a file with all of the signed receipts from sending things to them certified, return receipt was the ONLY thing that made them pay!!

A few years later we had a pediatrician I know tell us that it took them over a year to reimburse her for vaccines she gave to patients. Payment was over $50,000!

Whatever you do, send EVERYTHING to them and get a receipt showing delivery!! they used to deny just about everything the first go round! And the mental health benefit was a myth - they said they had benes, but they didn't ever pay!!

Susie

 

[DaizzyBee]

Hi missmell

I have to agree, I'm mourning the loss of Cigna for you now that you are changing to Aetna. I know everyone has different experiences, but mine were horrible. I had coverage for ALL services, just each may carry certain copy levels. Needless to say, everything I requested - pap smear, birth control, was initially denied coverage. I then paid out of pocket, was then reimbursed. I didn't get paid back for two procedures totalling over $500 until many calls and a photocopy of my healthcare benefit plan sent FROM THEM.

I pray you have better service with them, this was a few yrs ago, so maybe they have wized up. I know that my employer is getting close to cutting them completely from the roster because the HR department has been an Aetna liason, not the HR rep they have hired.

Good luck to you with all going on,

~Heather