Denied 2nd Night Hospital Stay For Gastric Sleeve!

[kksinisi 25]

I was sleeved on Nov. 1st, and it is standard per my surgeon for a 2-night stay in the hospital. I got a letter this weekend from United Health Care, stating that they are denying coverage for 11/2 on in the hospital. The letter states that the second night's stay was not medically necessary since I did not have a fever, complications, bleeding etc. etc.

Has anyone else experienced this and how did you resolve it?? I certainly cannot afford a whole day and night's hospital bill, that's for sure! Any insight would be greatly appreciated!

[Shae 44]

Something doesn't sound right. Everything should have been approved prior to surgery. The doctor's office should have worked out the details about how long the hospital stay was scheduled for and gotten it approved before setting a date. I don't know about these things except from other people but if it were me, I would get in touch with the doctor's insurance coordinator first.

Good luck. Paying for an overnight stay at the hospital would suck because then you would have to pay for any and everything they gave you from pain meds to IV fluids to meals to toothpaste!

Keep us posted.

Shae

[guzel 11]

I would start with your Dr's care coordinator they had to have submitted paper work for pre authorization. If a two night stay is your Dr's standard of care they must know this. Also, who gets to decide what's medically necessary? I would ask your Dr why he made the decision he did, he obviously felt it was necessary and might give you some info to go to the insurance co with. Good luck.

[100%Sleeved 148]

Wow that sucks. I hope I don't have that problem because I spent 4 nights in the hospital.

[former_vbg 198]

I concur with the advice already stated here. Aetna only pre-approved a 1 night stay also, but I ended up staying 2 nights. I knew that going into surgery and so when they wouldn't release me after 1 night due to not getting in enough fluids and such, I made sure to talk to someone from their admissions to be sure they were on top of this. What they told me is that they would be submitting contacting Aetna that day to let them know why I wasn't being discharged and that it wouldn't be a problem. I made it clear I couldn't afford a 2nd night stay on my dime.

I didn't have any issues with the billing thank god, but I did worry for a few months that I would start getting misc. bills on this. Aetna told me that after surgery, the hospital has up to 6 months to submit bills, so technically I have 1 more month before they could sneak something in, but I'm hoping that won't happen.

The key is did your Dr.'s office or the attending Dr. while you were at the hospital do the proper paperwork/ insurance approval for the 2nd night. Your in a vulnerable position after having surgery and should be able to rely on the medical professionals to know what needs to be done in these situations.