[MA] How to prep to file appeal for Acute Rehab from UMR/United (due to Hospital Error)?

SUMMARY: My Parent (65F) had an unexpected heart attack, requiring triple bypass surgery. Her medical team recommended she go to a ACUTE INPATIENT REHAB FACILITY after discharge. However, the hospital made some mistakes, delaying discharge.

INSURANCE: The hospital clerk mistakenly referred my Parent to a SUBACUTE Inpatient Rehab Facility. The SubAcute Facility then submitted a Prior Auth to UMR/United, which was approved.

After this was approved, the hospital's mistake was discovered. The hospital then correctly referred my Parent to an ACUTE INPATIENT REHAB Facility. The Acute Facility submitted a Prior Auth to UMR/United.

For the Prior Auth, UMR/United's Medical Doctor is reviewing my Parent's medical records and asked to speak to my Parent's Hospital Doctor in order to make a decision.

Realize there is a possibility UMR might deny the referral to an ACUTE facility, and then the family will have to appeal. If we have to appeal, are there specific phrases or facts we should use in our appeal? We don't want our Parent's care to be reduced due to the hospital's mistake.

If it matters, my Parent has UMR/United, and we don't know if she has Medicare/Medicaid as secondary.

Thanks for your help.

submitted by /u/Throwaway_Sympathy
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