Denied Claim for 3 day hospital stay as "Medically Unnecessary" appeal guidance.
Short story of the scenario.
Had an ER visit (Weekend) resulting from what I would call dangerously high blood pressure of 213/98. Tests taken, results sent to a Kidney specialist because of possible signs of kidney damage (blood in urine ect..). They gave the option to admit into the hospital or go home and schedule an appointment with the Kidney doc (days later). Choose to go home (with meds).
Blood pressure still in the 200’s (even on the meds for 2 days) when seeing the Kidney specialist. Kidney specialist advised and phoned ahead to admit through the ER (again) to get the blood pressure down for a biopsy. This took 3 days.
Just received a letter denying the 3 day stay as medically unnecessary by their “experts”. And isn’t covered.
I haven’t got the total for what this will cost, but I bet its a lot. Met the deductible for sure.
I am guessing they aren’t looking at, or don’t have the info on the kidney doc advising to admit to the hospital to get the BP down to mitigate any further kidney damage. Anyway. This is the first ever event where an ER or hospital stay has ever happened. Not sure how these go and really how to properly appeal. There is information in the letter, but I am sure it isn’t telling the best way to go about this. Seems like I should get some statement from the Kidney doc as a first line. Any comments are appreciated.