Posted on 01/10/2014 11:47:53 AM PST by CheathamCountyTN
OK, people assumed this had just happened.
So the policy went into effect prior to January 1st.
Not a good outlook for legal action, other than bankruptcy.
But still have her find a good advocate.
From your description it is certain she contracted the infection before the policy went into effect, unfortunately.
I think the problem they’re having is with the reason a hysterectomy was performed if the admitting diagnosis was a bacterial infection inside the gut. That’s something for the doctor to explain to insurance in the appeal. They’re seeing it as someone getting rear ended and claiming to need a new headlight.
All they knew when she was rolled into the operating room was that she had a major infection somewhere..probably in her belly since that was where the pain was. I asked her if she knew whether the docs could have gotten the infection out (her belly was FULL of pus..docs said they had NEVER seen anything like it on a live person)without doing the hysterectomy but she wasn’t sure. The infection was in her fallopian tubes as well as everywhere else in her abdomen. This was a BIG emergency situation.
It sounds like a medical coding thing. That’s not my line of business, but as long as the hospital records show an immediate need for removal of the uterus and related girly parts, it shouldn’t be too hard to appeal. It’s not like it was a face lift thrown in on a claim. Most importantly, glad she’s ok.
So if you have cancer but don’t know it and you go to the doc the same day your insurance policy goes into effect and, after 3 weeks of testing and searching for a cause for your symptoms, you’re diagnosed with cancer, that’s considered pre-existing? How could she have known she had an infection like that if she had no symptoms? Seems like if the illness reared its ugly head on the day the policy goes into effect, that’s an unlucky coincidence for the insurance company.
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