Medical insurance appeal

[takeonyou]

My son broke his arm last week and it required surgery at the large local children's hospital. He was transferred via ambulance since his arm was in 2 pieces with tissue caught between. He was admitted that night and had surgery early the following morning and ended up with pins and rods in his arm.

Insurance covered both ER visits, the ambulance ride, and the actual surgery. They are denying the inpatient admission because a broken arm does not require a hospital stay.

I already filed an appeal and I am having the medical records sent over to the insurance company. Does anyone have any experiences they can share with me that can guide me along?

[6fsn]

I have nothing, but I hope your son feels better soon.

[takeonyou]

Thanks! He is doing better now. Just bored. I feel bad because we would usually spend our last few summer weekends at the beach, swimming with friends, etc. but he just can't do any of that right now. Plus, I remember breaking my arm at 5 (he is 6) and the boredom was awful, lol.

[takeonyou]

Thanks! I hate stuff like this. My stomach is in knots!

[aurora]

I also agree with appealing the decision (sbp has good specific advice). Health insurers love to deny things they hope you won't appeal to save themselves money, but I have succeeded in getting coverage in the past.

Hope your son recovers soon.