Posted on 08/12/2020 3:51:20 PM PDT by AzNASCARfan
“I don’t know if you are shilling for the insurance companies...”
Why in the world would you say that as I have nothing to gain from doing anything in this thread. The person asked for opinions from someone who has been in the business and I gave it to help with the experience areas I have. Contracting is that area for me.
“Or, of course, you could always cover the bill for the medical air transport if you don’t think the insurer should be bothered to re-visit their decision.”
None of us know the contractual agreement, so we can react only to what we know. The requester’s terminology was that certain things were not happening. But unless the terms of the agreement are known, either could be right. If there is a clause in the contract that describes the mode of return, and threatens already completed service payment by it, the insurance company can be over ridden at any time, but they don’t have to pay for it unless it breaches contract and a suite follows.
“Then there is alway the abitious young reporter looking to stick it to the ‘man’.”
Strong armed tactics don’t work with major companies. They deal in money the little guy doesn’t understand other than a figure. Unless certain people start looking into the incident, like the FTC, the AMA, or adjoining organizations, the major company is bulletproof as they can stall out the little guy, if they are malicious enough to do it, and finally settle out of court at the request of the little guy normally far below the amount named in the action. Happens all the time.
rwood
I just wanted to say thanks to everybody that responded. I am way out of the loop compared to my daughter and my wife on this subject but they were both stressing out feeling like they were being held hostage and not getting any answers nor knowing how to proceed so I thought I would hit up the forum for some advice. They came and read the thread and said thanks, we may need to try some of those avenues.
So we are currently into the 3rd attempt at a pre-authorization for the flight... She has never even got a denial letter explaining anything, even from the first attempt and thought she needed that to fill out paperwork for the appeal. Each time she talked to the patient advocate about it, she told her that they were going to try another pre-auth and that if she appealed, it would put the pre-auth on hold until they dealt with the appeal, which could take even longer than two weeks, so they pretty much talked her in to waiting on the appeal and letting them try to get it authorized.
Today is two weeks since the last one was sent in and they told her it would probably take two weeks before we knew anything. We still have not heard anything official, but yesterday a girl that was on his transplant team came in and gave Jaxson a hug and told him she was going on vacation next week and expected him to be gone when she got back. My wife also said they came in and gave him a covid test today so she feels like the wheels might be turning.
Thanks again!
Just a quick update to tell you that my wife called me today and tell me Jaxson’s patient advocate just came in and told her to start packing because they were flying back to Phoenix tomorrow... Ended up doing the hospital to hospital transfer and he will be discharged from here whenever they think he is ready I guess. His legs have gotten strong enough and he has progressed on his daily walks to not need his walker any more and yesterday they even unhooked him from his ventilator for the walk.
Great news! I wish everyone there all of the best.
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