"Skilled need" turned down by insurance please help!

My mom was supposed to be transferred today and all of a sudden her insurance denied her. They said there is no skilled need. She has a trache, a Gtube and cannot move yet they want to send her home! We cannot possibly take care of her yet! She is just getting out of the hospital going to a SNF! Anyone have any experience with arguing with the insurance? She is getting better and just started to eat!

hi lbc! my experience they deny everything in hopes people cave in and pay, they even denied my copter ride so I called and they said ooohhhhh you were unconscious so they have to pay I will resubmit, so that was the last I heard!! I am so sorry you are going thru this, what did the case worker say? She is definitely snf material!! I did come home with a peg tube because it had to remain 12 weeks . if you still cant get approved call them back and say you want reconsideration,take a deep breathe first and try to remain calm also maybe the snf could advise after all they will be the breadwinner for sure @ 300 a day! This ticks me off when we have to fight them-my sister had to set up 3 way call and went round and round about coverage dates and finally said look he was covered on that date you just told me, you guys fight it out we are done goodbye and that also worked! Honestly they cannot send her home with a trach try not to worry too much, I was lucky I guess - went right to rehab hospital after nuero hospital, hang in there I hope things get set up, let us know please~ keeping you and yours in thoughts and prayers~~

Yes Ron it is so frustrating! My mom only went to the doct once, my dad too and he paid insurance for nearly 40 years and now when they truly need it, they get denied? I’m so worried I’m sick to my stomach, how dare someone say without even seeing her how her condition is! It’s not even been 4 months! I will fight tooth and nail if I have too, it’s a shame though! It’s not right! But thank you Ron!

Hey Chris,

You might want to ask the insurance carrier what is their defination of needs regarding skilled care and how is it they went about denying your mother this care--? Keep hammering them Chris, typical of insurance companies to deny deny deny(with the hope that you the insured, will just agree with their decision). If necessary ask the Neurosurgeons office to re submit their orders for a skilled nursing facility, sometimes it comes down to using the 'right' wording when it comes to insurance paying out or not. How Frustrating !

I so agree with Ron ... you need to fight the claim... also, to help you with some resources and such...please view the front of BAF website...some very helpful information about insurance, caregivers, etc.,


~ Colleen