Need Help Understanding Insurance Letter/ Denial
Hi, I need help understanding the letter I just received from my insurance company after a recent hospital admission.
Letter States:
"We review health care services requested for coverage under the terms of your health benefit plan to determine if they are medically necessary, as defined in your plan document. We received a request to review an admission for you. Based on the information submitted, we have determined that the requested service(s) is/are not medically necessary.
Your facility should not bill you for the cost of the services you received. If you receive a bill from your facility that is associated with this admission request, call the number on your health plan ID card.
We looked at the medical information made available to us. We reviewed the health plan criteria for admission. We have determined that this stay does not meet these criteria. The hospital inpatient admission is not covered. Services may be provided at a lower level of care in the hospital.
Completed by a Board Certified Physician Reviewer
Denial Code: N/A
Claim Amount: N/A"
Just trying to understand what this means and if I need to follow the appeal steps listed on the next page now or wait and see if I receive a bill from the hospital and go from there. Just confused by all of this and what it means. It was an in network hospital and a 4 night stay. Any help understanding this letter is appreciated.
submitted by /u/Throwaway2456786
[comments]
