This is going on with a lot of plans. Cigna is a major perpetrator, exposed recently as having routinely denied claims by the thousands without even being medically reviewed. Think clearly about “health insurance.” They couldn’t care less about your health. They are not healthcare organizations. They are insurance companies, and they make money by taking your premiums and denying your claims. States have insurance commissions who are supposed to oversee this stuff but they are unreliable. The only recourse is persistence.
They are banking on you dying soon.
This is exactly it.
A MCare Advantage company may issue blanket denials for all skilled nursing requests from a hospital on the first request for a patient, or at least refuse a significant percentage (hmm, perhaps a quota so as not to look suspicious?).
They very well know that in the time spent on an appeal or “peer-to-peer” doctor call required, a certain percent of patients will die or get better and go home, thus avoiding any skilled nursing payments. So the hospital eats the extra days, because they get paid by diagnosis code, not for the extra days needed to jump through hoops.