Hospital readmittance for sick infant denied – help w/ appeal

When she was less than 2mo my daughter was admitted to the hospital via peds ER due to severe dehydration (likely enterovirus), vomiting, diarrhea. She was put on IV fluids & monitored. We were discharged a few days later. When we got home it was clear she was not fully recovered (still had diarrhea & was not feeding enough). We called and spoke with the attending physician directly who told us to bring her back immediately and arranged for a direct admit. She was in for 3 more days after this.

Months later, the claim for the 2nd hospital stay was reprocessed and denied with the code YF2 “Readmittance too soon after discharge.” This has cost me almost $4000 because it partially reset my deductible and out-of-pocket max.

The readmission claim was denied because there is an inpatient claim with the same or similar condition previously filed and it does not meet the time allowed between hospitalizations. The member is responsible for all charges indicated in the “Amount the provider can bill you”. ”

I think it is self-evident that the 2nd stay was medically necessary given that she needed IV fluids for 3 more days; it was in effect a continuation of the 1st stay.

I talked to the hospital months ago and they said they were in contact with the insurer, but nothing has happened. I am planning to file an appeal before the clock runs out.

Do you have any advice for winning the appeal?

I have access to all provider notes from both stays in MyChart. I am planning to submit all provider notes from the 2nd visit, plus discharge instructions from the 1st visit, which mention “strict return precautions.”

Is there anything else I can do to help?

This pisses me off because if they never discharged her in the first place we wouldn’t have had this problem.