Adverse Determination
Hello all! I need help on who to contact. My united healthcare insurance denied 2 claims (see details below) where I was admitted to the hospital, claiming it was not medically necessary to be admitted. Who do I contact to get this fixed? Obviously it was medically necessary if a doctor admitted me, right? Ugh! Do I try to get the billable codes changed? Try to appeal? I’m lost and do not have the money to pay this!
Claim 1: at 35w pregnant, my fetus failed a nonstress test and an ultrasound. Concerned for the baby, doc sent me to the hospital and I was admitted until they got a perfect nonstress test (about 8-9 hours) Claim 2: I had gestational hypertension during my pregnancy. 5 days after birth I had a huge spike in my BP and some related health issues (bad headache due to bp). The doctor wanted me to be admitted to watch my BP, run tests, and adjust my meds. I called before I came in and spoke to the doc on call in labor and delivery and they told me to come.
submitted by /u/Muted_Disaster935
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