CareSource Denied My Son’s ER Admission
Hi everyone, I’m feeling pretty stressed about a situation with my son’s recent ER visit. After he experienced labored breathing due to RSV, I took him to the emergency room. Initially, he seemed stable, but his oxygen levels began to drop over the next few hours, and he ended up being admitted to the children’s hospital for two nights.
Now, CareSource has denied the claim, stating there was no documentation of low oxygen levels or difficulty breathing at the time of admission. However, this was the very reason the doctor decided to admit him! I have records showing his oxygen levels reached 92%, but they failed to capture that it later dropped to 89%. There were also observations of retractions noted in his medical records.
I believe this claim should be approved, and I’m feeling overwhelmed as I’ve already reached out to both the provider and CareSource. Now, I just have to wait 30 days to see how it plays out, which has me worried about the financial implications. Is it common for insurance companies to deny claims like this?
I’m really sorry to hear about your situation; that sounds incredibly stressful for you and your son. It’s unfortunately not uncommon for insurance companies to deny claims, especially for emergency services. They often look for specific documentation or criteria before approving payment, and sometimes important details can get overlooked in the process.
Here are a few steps you might consider taking:
Documentation: Make sure you have all the records regarding your son’s condition, including the ER visit notes and any lab results. This can be crucial in contesting the denial.
Appeal the Denial: You have the right to appeal CareSource’s decision. You can write a formal appeal letter that outlines the circumstances of your son’s condition and includes any supporting documentation, such as notes from the doctors regarding the necessity of the admission.
Contact a Patient Advocate: Many hospitals have patient advocates on staff who can help you navigate the insurance process and may be able to intervene on your behalf.
Follow Up Regularly: Keep in regular contact with both CareSource and the provider to stay updated on the status of your appeal.
Understand Your Rights: Familiarize yourself with the specifics of your insurance policy. This may help you understand your coverage and any criteria that need to be met for approvals.
It’s understandable to feel overwhelmed, especially when it comes to healthcare and finances. You’re not alone in this, and with persistence, you may be able to successfully appeal the denial. Hang in there!