CareSource Denied My Son’s ER Admission
Hi everyone, I wanted to share my experience because I’m really worried. I took my son to the ER due to labored breathing following an RSV diagnosis. Initially, he was stable, but over the next few hours, his oxygen levels began to drop. He ended up being admitted to the children’s hospital for two nights. However, CareSource denied the claim, stating there was no documented evidence of low oxygen levels or breathing difficulties, which is baffling because that was actually the reason for his admission!
I saw notes indicating his oxygen level dropped to 92%, but they didn’t update when it went down to 89%, and they even noted signs of retractions. I don’t think this claim should have been denied, and now I’m really stressed out. I’ve reached out to both the provider and CareSource, but now I’m left waiting for 30 days to find out if I’ll face financial trouble because of this situation. Is it common for insurance companies to deny claims like this?
I’m really sorry to hear about the situation you’re experiencing with CareSource and your son’s ER admission. It’s incredibly stressful when medical care is needed, and then insurance adds extra complications. Unfortunately, claim denials do happen, sometimes due to missing documentation or miscommunication between the hospital and the insurance company. It sounds like you have valid reasons for the admission based on your son’s condition.
It’s good that you’ve already contacted both the provider and CareSource. Make sure to keep a record of all communications and documents related to the case—it may help if you need to appeal the denial. You can often request a detailed explanation of the denial in writing, which might give you more insight on how to address it.
In the meantime, if you’re feeling overwhelmed, consider reaching out to a patient advocate. They can often assist in navigating these kinds of issues with insurance companies. Also, look into any financial assistance programs that may be available through the hospital or local health organizations in case the claim doesn’t go through.
You’re not alone in this situation, and many families face similar challenges with insurance. Stay persistent—sometimes a follow-up can make a difference. Wishing you and your son the best during this difficult time!