While I’ve been flirting with death all year, my health insurance declared a particular stay at the hospital "medically unnecessary". The first appeal was denied, would appreciate any help how to navigate this nightmare. Started in Seattle Washington, now I’m in New York. I have a PPO.

Hi all, I’ve had a hell of a year. Five surgeries so far with, hopefully, a final one scheduled for November. Started with an intestinal blockage and now we’re here. On this wonderful journey, I’ve tasted the delights of septic shock (30 to 40 percent mortality rate) and severe sepsis, not to mention the sight of my intestines spilling onto the floor from an incision coming loose around my stomach.

So, another wonderful side effect I got going on is that I cannot eat. As a result, I have a PICC line that transmits something called TPN (it looks like milk) into my veins. Essentially, I’m on a long term IV. One of the tricky things with these central lines (like PICCline or Port etc.) is that if they get infected, your blood turns toxic and you get sepsis, which is quite serious.

Alright, so, the crux of the matter: when they installed the PICC line, the skin around it went absolutely crazy, cracking and oozing puss, they took it out because they were afraid I’d get an infection. They installed a Port, my skin reacted similarly, and this time it did get infected. (“Grossly infected” is how the somewhat comically shocked and disgusted doctor put it as they took it out of me.) This sent me into Severe Sepsis and it was a touch and go for a second there, but I recovered.

They put in a third PICC line, trying different materials, but it was a no go. The skin around it started oozing again, or “weeping” as the doctors put it. I was tap-dancing on the path to infection and then severe sepsis once again, which… yeah.

Around this point, I had started talking with a new colorectal surgeon in New York and became his patient. (Up until this point I was in Washington, Seattle.) When I told him that I’m once again tap dancing on the road to severe sepsis, he told me to come to New York and the people in his hospital are great with skin issues around central lines.

So off I went, and stayed at the hospital for 3 days. My skin looked weird as hell, but they kept an eye on it, tried different materials. It got a little better, they sent me home.

This is the visit the insurance is declaring “medically unnecessary” and it’s a hefty 60k hospital bill. They’ve already denied the appeal from the hospital, and now it’s back to me to do an “external review”. I want to make the best case for myself, but I also don’t know where to start. (I do have ARAG legal insurance from my work, if that could help anything.) My doctors are just throwing their hands up and being like: “Yup, welcome to America, this is what this is.”

I read the denial letter from the insurance company and it was confusing. There was no mention about my skin (which, by the way, did get infected three days later after I got discharged from the hospital and I had to come back in with a fever, and they caught it before it got septic, and took out the PICC line.) So maybe the hospital/doctors didn’t mention the whole skin issue to the insurance? I mean, to be fair, for many of the doctors there it was their first time seeing me, and my skin issues were the least “medically sexy” thing I had going on, so I’m guessing they didn’t dwell on it. (I don’t want to pour more medical gore into this post, but if you saw me right now with the giant fistula on my stomach from whence my refuse travels outward like a shit geyser you wouldn’t necessarily think “ah, skin issue.”)

Anyway, thanks for listening and any help would be greatly appreciated. Thank you.