When insurance doesn’t cover a hospital stay...

In the US there’s an ongoing debate regarding health insurance, wether it’s really needed and who should be running it.

...we’re not here to talk about that.

What we are here to discuss is what happen’s when you have health insurance that can be increasingly frustrating and difficult and labels absolutely necessary things “not medically necessary” for stupid reasons. Now why does a health insurance company do that? Long story short; They want money and they're greedy.

I was hospitalized twice within a week of each other. Both times in the pediatric intensive care unit at my local hospital (actually two hospitals...I’m glad I live in Boston -_- MGH and MEEI are connected to each other) once as a direct urgent admission from the result of a laryngoscopes and extreme exhaustion (which what do you know makes breathing harder!) for another large multi-specialty  workup and monitoring over a four day period, and one night on the regular pediatric floor with close monitoring from one of the senior nurses. They would have kept me longer had we not had a Neurology appointment with the Dystonia/movement disorder clinic at Boston children’s the next day. They scheduled my surgery/EMG for That’s Wednesday (the day after Neurology) which started the second thankfully shorter admission to the PICU when I woke up in respiratory distress and unable to speak or swallow. After being kept overnight and having a swallow study done in the morning we were allowed to come home.

When we got home we received a letter that my 4 day admission from earlier that week has not been covered as it was deemed “not medically necessary due to no laryngoscopes being performed and no antibiotics given” My vocal cords are paradoxical you idiots I don’t have the croup and a laryngoscopes was performed as the grounds for admission! We called the insurance company the next day but because I could not give verbal consent to let my mother speak (I couldn’t speak at all for two weeks!!) with the lady on the phone she said there was nothing we could do.

Luckily my ENT came to the rescue, and wrote a note saying the admission was in fact needed and should be covered by insurance.

In conclusion,
Should insurance be difficult, talk to your doctor or their secretary or (if possible) give the person on the phone a very stern talking to with proof why such a hospital stay was required.

Until next time,
Max