Opinions on denied insurance

Hello all,

My mom has been going through it this year. Broken arm (L), rotator cuff (L), rotator cuff (R) and was about to have surgery on the Right shoulder injury.

She recently fell and damaged her thigh. In and out hospital and urgent care for a couple months.

Went to hospital a couple days ago and she’s been having to stay overnight. She has wound vac machine attached to the bed draining liquids.

Her insurance Humana just denied a wound vac machine so she cannot go home. I want to call the case manager and appeal, but unsure of how to describe this medical necessity.

My dad takes is a retired marine and takes care of her all day. She’s able to walk and live normally, just has pains here and there. Which we get help if she needs. I recently moved back in, and 1/2 the week I work from home and I am able to help.

Due to the denial of the machine, the hospital is recommending long term care facilities or even skilled nursing facilities. My mom broke down, I’d visit her everyday, but we do not want this option.

The hospital said the insurance did not give reason for the denial. The nurse said quietly that calling them back and asking to speak to the case manager would be a good idea.

Please if anybody can give me any advice, hope.

Thank you

submitted by /u/agasnkr9
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