NICU stay Anthem BCBS denial question
Hey guys quick question and hope this is the right place. So our daughter had a 5 night stay in NICU and 5 nights in NICU step down. Got a letter from BCBS saying the initial 5 nights were medically necessary but another letter saying the “extension” for 5 more nights is not medically necessary. When I called they didn’t even have a record of this letter being sent and only told me that the hospital may have to send in more records to support the claim(the letter states the hospital has also been contacted).
At this point I’m wondering what the next steps should be as I’m not sure if I need to file an appeal soon or wait until I hear back with more details. The letter says she didn’t have breathing or feeding issues. She was in NICU for being premature, respiratory problems, low blood sugar and feeding difficulties. The hospital admitted her to step down unit when these issues improved but they still had to monitor her closely especially since their policy keeping babies for a specific number of days after a dose of caffeine is given to assure another dose isn’t needed. It’s not like we had a choice in keeping here there or taking her home- pretty sure child protective service would be knocking on our door if we tried! Not sure if this would be considered a provider liability issue if denied again? Any advice is much appreciated!
submitted by /u/-Luro
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