QUESTION
What recourse is available if post surgical rehab is needed and denied by insurance?
Asked on Jul 31st, 2021 on Insurance - Pennsylvania
More details to this question:
My husband had a total knee replacement. He also has Parkinson's and arthritis in his other knee. His docs had planned for him to go to acute rehab 2 days after surgery, but was denied after waiting 3 days for an answer. Insurance offered sub-acute rehab as an alternative, and case manager spent 4 days trying to find a bed, and notified Aetna when one was found. She heard nothing until Friday 7-30 when that was sent to a peer review which denied the sub-acute rehab. My husband will be sent home to me. I am his 75 yr old wife with health problems and no help and a 2 story house.
1 ANSWER
If you believe that the policy should cover the rehab, you would proceed through whatever dispute resolution procedure is called for in your insurance policy (for example, it may require arbitration of any disputes). If the policy doesn't set forth a method of dispute resolution, or you have exhausted all procedures called for by the policy, you would sue the insurance company for breach of contract.
Answered on Jul 31st, 2021 at 8:25 PM