A Benefit Advocates’ client, Mr. J., contacted us after spending months trying to resolve a claim issue. His health insurance denied his cardiac rehabilitation, and he was billed $5,000 by the care provider. The rehab was denied because the insurance required an inpatient admission due to a cardiac event prior to the rehab. Mr. J. was in fact admitted to the hospital from an emergency room visit for pneumonia. During the hospital stay he was also diagnosed with systolic heart failure and cardiomyopathy. The insurance denied the cardiac rehab because the initial diagnosis was pneumonia. Benefit Advocates filed an appeal to the insurance company, which included documentation from the cardiologist and discharge summary notes from the hospital. All documentation indicated Mr. J. was diagnosed with congestive heart failure during the hospital stay. Based on the documentation submitted, the insurance company overturned the denial of the cardiac rehab, and all of the claims were paid.
Mr. J. was ecstatic with the good news. He indicated he would have never been able to resolve the claims issue without our help. He was very impressed with the professionalism and the thoroughness of which we pursued the issue.