Failed Induced Labor, Hospital Stay Denied
Hey all, I have a particular situation here that I'm hoping to get some advice on. Curious to know how to approach an appeal to our insurance company for not covering our first try at inducing.
At 39 weeks and 6 days, at my wife's weekly prenatal OB appointment, she had elevated blood pressure and the doctor sent us to the hospital for further testing and monitoring. We were told we could induce labor that day if we felt ready. Considering we're a day shy of 40 weeks, we figured why not, we're at the hospital. We were not pushed to stay or go, we were given the option.
In hindsight we should have asked for a black and white recommendation from the doctor on whether we should stay or go. In the after care summary, the note reads that we were given the option to go home or induce and "(my wife) accepts the induction of labor"
We were admitted to a room in Labor and Delivery and started inducing around 2pm. There was little progress by 10pm, and at 7am the next day we were informed it may not be best to keep pushing induced labor as we could significantly increase the chance of hemorrhaging or need for a c-section by 30-40%.
The doctor said we have the option to go home and return in 36 hours. They said statistics show it's more dangerous to give birth at 41 weeks, so they would absolutely continue inducing, but my wife's body wasn't yet ready so they didn't feel good about "pushing nature." They didn't explicitly recommend we go home, but when we opted to do so they agreed it was a really good idea.
We came back 36 hours later to start inducing. 24 hours after that we were in labor, and our baby was born that evening, about 27 hours after our second try at inducing. Everything went really well on our second attempt with no complications.
Insurance has sent us some mail indicating that our first go at inducing will not be covered at all, claiming our stay does not meet the guidelines (for a hospital stay), citing the following:
(the reason for our stay) is we were watched closely we did not have to be admitted as an inpatient in the hospital for this car the reason is you were watched closely at the hospital you did not have a severe illness you were stable you had tests that did not show any problems that needed inpatient only treatment the records showed the patients medical condition was stable you could have gotten the care you needed without being admitted inpatient at the hospital -the hospital inpatient admission is not covered. submitted by /u/Significant_Owl_6897
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