My wife recently was admitted to the hospital and had her gallbladder removed last week.
She was advised by her PCP to go to the ER after he reviewed her bloodwork/Ultrasound/MRI results. Her bloodwork indicated her liver function was off and the MRI indicated a gall stone was stuck in the bile duct along with her gallbladder filled with stones. She was also in excruciating pain and could not eat anything for the 3 days prior to being admitted.
My wife has BCBS which ended on 7/1/2021 and also UHC which started 6/1/2021 so she was double insured. BCBS sent us a letter a few days ago saying that after reviewing her results that she has medical condition that requires a hospital stay. UHC sent us a letter today saying the medical condition does not require a hospital stay and will not be covered.
We already met our max yearly OOP with BCBS. Should we challenge the UHC denial? I’m assuming BCBS will cover it since they sent a letter saying she does in fact require hospital care. Should I just send UHC, BCBS letter and say this insurance thinks her condition required hospitalization? Is their a place to report UHC? If one insurance company says it’s medically necessary to be admitted to a hospital and another one rejects it , it seems like UHC is doing something shady and rejecting valid claims.
Also what’s the point of sending out a denial letter 1.5 weeks after being admitted?
submitted by /u/sheik482
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My wife recently was admitted to the hospital and had her gallbladder removed last week. She was advised by her PCP to go to the ER after he reviewed her bloodwork/Ultrasound/MRI results. Her bloodwork indicated her liver function was off and the MRI indicated a gall stone was stuck in the bile duct along with her gallbladder filled with stones. She was also in excruciating pain and could not eat anything for the 3 days prior to being admitted. My wife has BCBS which ended on 7/1/2021 and also UHC which started 6/1/2021 so she was double insured. BCBS sent us a letter a few days ago saying that after reviewing her results that she has medical condition that requires a hospital stay. UHC sent us a letter today saying the medical condition does not require a hospital stay and will not be covered. We already met our max yearly OOP with BCBS. Should we challenge the UHC denial? I’m assuming BCBS will cover it since they sent a letter saying she does in fact require hospital care. Should I just send UHC, BCBS letter and say this insurance thinks her condition required hospitalization? Is their a place to report UHC? If one insurance company says it’s medically necessary to be admitted to a hospital and another one rejects it , it seems like UHC is doing something shady and rejecting valid claims. Also what’s the point of sending out a denial letter 1.5 weeks after being admitted?
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