Any suggestions to help my mom?

Hi everyone. I’ll try to explain the situation as best as I can….

My mom has had an open wound on her leg for several months now. The Dr. at the wound clinic determined that regular wound care wasn’t helping and recommended to have her use a Wound Vac.

Her Dr. sent a request to her insurance (Regence), which, seemingly, got approved and several boxes of wound vac supplies/ dressings arrived at our house

But maybe a month after receiving everything, a letter that was delivered to her Dr. (not to my mom) stated that insurance would not cover the Wound Vac treatment

And the worst part is that this letter was not delivered/received until a full 2 weeks after the deadline the insurance co. placed for a peer to peer review. And they have recently denied the appeal from the wound clinic stating that the clinic has not provided proof that previous treatment was attempted for at least 30 days before prescribing the wound vac (even though my mom was doing the regular wound care for at least 2 months)

My mom is beyond upset and doesn’t know what else to. This wound vac apparently cost $100+ a day for us to have at home.

Is there anything else my mom or perhaps the wound clinic should do to get this treatment covered? I don’t understand why insurance seems to think she hasn’t tried other treatments before getting the wound vac

I keep asking her if the wound clinic/ affiliate hospital has a patient advocate department she can ask for help, but I don’t believe she’s asked yet for some reason…..

I’ll try to get more details from my mom to answer any questions you may have

TYIA

submitted by /u/Interesting_Bed134
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