Retroactive days are not approved
I had a tumor removed from my lung in October 2022. It was a major surgery and it went pretty straight forward. The doctors told me to expect a 3 to 5 day stay in the hospital.
I was admitted on 10/19 and had the surgery that day. I was in the "critical care" unit until my release on 10/23. I was told that critical care was between normal bed and icu and pretty typical for heart and lung patients to recover in.
Anyway, I just received a letter from my insurance company that is titled – Notice of Denial, Change, or Delay in Your Services.
Service Requested: Inpatient Surgical Admission, Continued Stay
Date of Service: 10/21/23 – 10/23/23 (obviously those dates are wrong since they haven't happened yet – maybe just a typo?)
We have important information about the request for inpatient surgical admission, continued stay.
Based on our guidelines, we have decided to:
Deny your request for this service.
Date of request: 1/31/23
Reason for our decision is:
The request is denied because authorization was not requested for these additional hospital days in a concurrent timeframe. Retroactive dates are not approved.
So to me it sounds like the hospital only planned on me being there for 3 days (10/19 through 10/21), but since I wasn't released until the 23rd, perhaps they tried to get approval from the insurance company after the fact. This is just a guess on my part. I'm really not sure what the process is or was in this case.
Anyone here know what this letter is saying? How do I appeal this – like what's my argument? To me it sounds like the hospital screwed up by waiting too long to request the extra days. I literally couldn't leave any sooner as I had two big drainage tubes sticking out of my rib cage. They removed one on 10/21 and the other on 10/22. I was also experiencing some heart issues that are not uncommon for thoracic surgery (afib, tachycardia). I'm pretty healthy and was tolerating the pain just fine – didn't need any hard narcotics after being discharged…. so I feel like it was a pretty typical stay for this type of surgery. I sent a copy of the letter to my provider in hopes that they will help out, but haven't heard back yet.
Any advice would truly be appreciated!
submitted by /u/JohnnyQuest69
[comments]
