Seeking Advice on Appeal Options for Insurance Denial of Medically Necessary Inpatient Stay
Hey,
I recently had a bike accident and broke my tibia. It was a grade I open tibia fracture. I have Anthem BlueCross/BlueShield insurance, and the hospital where I had my surgery is an in-network provider. A few days after my discharge, I received a letter from the insurance company stating that my inpatient stay post-surgery wasn’t deemed medically necessary.
I spoke with my provider about it, and they mentioned that this is a common issue with insurance companies and not to worry. The provider's office called and advised me to appeal the decision, explaining that I was on IV antibiotics due to the grade I open fracture to prevent infection at the wound site. I followed their advice and appealed, but I'm still concerned that the claim might be rejected.
The two-day inpatient stay cost around $90k, an amount I can't afford, even with a three-year installment plan without interest, as I am an international student. Can anyone advise on potential options if the insurance company rejects my appeal?
Location: Bloomington, IN. Thank you.
submitted by /u/World-Explorer53
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