Caring Currents

Insurance Coverage: Denied!

Last updated: Apr 11, 2008


What do you do when your parent's insurance company denies coverage for the care that his doctor has ordered?

If you're anything like "Dona" and her mother, you'd file an appeal to make sure that your father could recover from his triple bypass surgery in the cardiac rehab center his doctor had ordered. According to Dona, who shared her story with the consumer finance blog

"My father's doctors, along with the hospital's case worker and my mother, tried to get their health insurer, Anthem Blue Cross/Blue Shield to approve off-site cardiac rehab. They initially approved the request and made arrangements at an approved facility. The day before checkout, March 19, Anthem changed it's mind. My father's doctors kept him another day to execute an emergency appeal. But to no avail, Anthem determined my father was "too healthy" and would have to go home (and basically perform self-care). "

A week or so after his family took him home to recuperate, Anthem reversed itself and approved the stay in cardiac rehab. The only hitch? They would only pay for the days immediately following his hospital discharge. Meaning, they would be happy to pay for his time in rehab, if only he could figure out a way to turn back the clock a week.

As many commenters pointed out, insurance companies may expect their customers to pay the disputed costs out of their own pocket while waiting for an appeal -- and hopefully, eventual reimbursement. But a cardiac rehab unit can cost hundreds or even thousands of dollars a day, and it's unlikely that many families can afford to pay those costs themselves while hoping for the insurance company to change their minds.

What else can be done in this kind of situation? Are the only choices to pay for the care yourself, or forego it altogether? If your family has been denied coverage for care, how have you handled it?

Image courtesy of Anthem Blue Cross Blue Shield