We live in South Carolina, and he has health insurance through the marketplace. No surgeons in SC can perform the surgery he needs, so his cardiologist referred him to a surgeon out of state. Everything was set up and ready to go, and then the hospital called, saying it was denied as it wasn’t an “emergency”, just “medically necessary” so insurance won’t pay for him to have it done out of state (this is despite the surgeon saying it IS an emergency procedure). But again, there is no way to get the procedure done in-state.
His surgeon is writing a letter of appeal, but they’re saying it could take a month for the appeal process and even then they may have to do it again. His heart may not last that long, and if it does it may still be too late to have a good outcome after surgery.
There is a different surgery he could get that could be performed in-state, but 2 cardiologists have agreed that this is by far not the most ideal procedure for him and he’d have a worse quality of life afterwards compared to the surgery they said he needed.
Are there any other options we’re missing?
submitted by /u/throwaway01957
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We live in South Carolina, and he has health insurance through the marketplace. No surgeons in SC can perform the surgery he needs, so his cardiologist referred him to a surgeon out of state. Everything was set up and ready to go, and then the hospital called, saying it was denied as it wasn’t an “emergency”, just “medically necessary” so insurance won’t pay for him to have it done out of state (this is despite the surgeon saying it IS an emergency procedure). But again, there is no way to get the procedure done in-state. His surgeon is writing a letter of appeal, but they’re saying it could take a month for the appeal process and even then they may have to do it again. His heart may not last that long, and if it does it may still be too late to have a good outcome after surgery. There is a different surgery he could get that could be performed in-state, but 2 cardiologists have agreed that this is by far not the most ideal procedure for him and he’d have a worse quality of life afterwards compared to the surgery they said he needed. Are there any other options we’re missing?
submitted by /u/throwaway01957 [link] [comments]Read Morer/HealthInsurance