Insurance is forcing unwanted hospital transfer
If there is a better sub for this question please let me know.
I’ll try to make this as concise as possible, while including all facts.
My brother has Anthem HMO insurance, he went to the ER at his local hospital with terrible pain in his stomach and blood in his stool. He was told to contact his gastroenterologist and sent home. He contacts the gastro and schedules a colonoscopy, soonest appointment available is 14 days out, he takes the appointment. 4-5 days later he returns to ER because of pain, they tell him he already has a colonoscopy appt there’s nothing more they can do, he is sent home again. The colonoscopy happens and he is diagnosed with ulcerative colitis and prescribed steroid sent home. 3-4 days later he returns to local ER (third visit) because he is still in terrible pain, cannot keep food down and very weak. They send him home and tell him to continue meds he will feel better soon.
Fast forward 48hrs and he’s in horrible shape. His wife is very concerned and takes him to a different in-network hospital. This hospital is 50 miles from home, his local hospital is 20 miles from home both are in the anthem network. Upon arriving to the ER he is admitted immediately, they get him on IV fluids, 4x the dose of his steroid as well as another medicine and pain meds. Within an hour he’s had a CT scan and the Dr has reviewed the results. The Dr says “he is appalled that the other Dr would send this patient home. He should have been hospitalized days ago. He’s was dangerously dehydrated and his entire colon is inflamed.” At the time he’s admitted he weighs 114lbs down from 155lbs just 3 weeks prior. He is told he will remain in the hospital until he can keep down solid foods and is gaining weight again, approx 5-7 days but could be longer.
He begins to improve and 3 days later is looking and feeling better. He is still on liquid diet and cannot be discharged. This is when insurance company contacts his wife, they state that he must transfer back to local hospital because it is “his” in-network hospital. His wife refuses but is told that it’s not optional. Tomorrow he will be forced to go back to the hospital that turned him away 3 times when he needed their help.
Is there any recourse for us to keep him at his current hospital where he’s receiving excellent care?
TLDR: can we prevent the insurance company from forcing a hospital transfer if both hospitals are in network?
We are in California if that matters. Any advice would be greatly appreciated. Thank you!
submitted by /u/kahnerparke
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