by mkusiak » Mon Dec 17, 2007 12:49 am
My father was paralyzed on Sept. 9th, 2007, after he suffered a accidental fall after his treestand gave out from beneath him. However, our insurance company has yet to pay anything since his date of injury, far over the typical 30 day time alloted. On November 9th, we were informed that as of November 7th, our insurance company had only authorized three more days, which would have been up the next day, November 10th. The reasons as to which were left unknown, to both us and to the facility he was receiving care from.
The only response we could get from our insurance company was that, ‘patients benefits are suspended due to claim investigation.' When we questioned them for advice or what they would like us to do, or where they would like us to admit him, we simply were left with a mere, ‘we're sorry ma'am.'
However we were aware the fact that our insurance company was battling the charges associated with my father going to that specific nursing home, as it was 'out-of-network'. Reason being, when we brought him back to his original hospital and admitted him into the rehab program in the closest proximity of our home address; therefore, complying with the insurance companies wishes by placing my father in a facility which would be ‘in network.'
We have adhered to everything that they had asked of us, though to date, our insurance company has yet to validate the fact that my fathers care will be covered by them. Ultimately, such actions, or lack there of, have implemented additional stresses on our own lives and financial stability, for a reason that is completely unjustifiable.
The problem with our insurance company needs to be resolved in a timely manner, now moreso than ever, as he is scheduled to be released from his rehab this Friday, Dec. 21st. However, our insurance company orginalled agreed to 8 weeks at Mayo Clinic- and he has only completed 4, as they had to divide his insurance into two phases, due to the restrictive nature of his braces. We do not want him to be released- because the chances of him being re-admitted after returning home would be rare. On the other hand, we do not was to re-admit him, come to find later that they in fact are not going to pay.
Is there any legal action we may take against them for not providing answers for such an extended amount of time?
The only response we could get from our insurance company was that, ‘patients benefits are suspended due to claim investigation.' When we questioned them for advice or what they would like us to do, or where they would like us to admit him, we simply were left with a mere, ‘we're sorry ma'am.'
However we were aware the fact that our insurance company was battling the charges associated with my father going to that specific nursing home, as it was 'out-of-network'. Reason being, when we brought him back to his original hospital and admitted him into the rehab program in the closest proximity of our home address; therefore, complying with the insurance companies wishes by placing my father in a facility which would be ‘in network.'
We have adhered to everything that they had asked of us, though to date, our insurance company has yet to validate the fact that my fathers care will be covered by them. Ultimately, such actions, or lack there of, have implemented additional stresses on our own lives and financial stability, for a reason that is completely unjustifiable.
The problem with our insurance company needs to be resolved in a timely manner, now moreso than ever, as he is scheduled to be released from his rehab this Friday, Dec. 21st. However, our insurance company orginalled agreed to 8 weeks at Mayo Clinic- and he has only completed 4, as they had to divide his insurance into two phases, due to the restrictive nature of his braces. We do not want him to be released- because the chances of him being re-admitted after returning home would be rare. On the other hand, we do not was to re-admit him, come to find later that they in fact are not going to pay.
Is there any legal action we may take against them for not providing answers for such an extended amount of time?
Posted: Fri Oct 19, 2012 07:07 pm Post Subject:
Sounds like it's her husband's problem, not yours. Quit crying.
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