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and then what?
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Insurance companies look at everything in terms of benefits vs. cost.
If the treatment has a poor track record, they will reject it. If the treatment does not prevent further decline, or the patient is terminal or non-compliant, they will not approve it. Mom is in PT rehab, but tries to get out of going when the aides come for her. She will say she has to poop, she will want to stay with visitors, she will tie herself up on the phone, says she has nothing to wear, etc. I know where this is going, soon they will just cut off the PT and she will not be able to return to her Assisted Living facility.
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are we talking about admission somewhere?
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Having worked for Cigna, I can tell you, any unnecessary expenditures devoted to a terminal patient (such as dementia), will not be a high priority. In any case, what exactly does his doctor think he can do for him? He is terminal, and any medical treatments are pointless, as are medications. I made the decision my husband does not have to see another doctor because no one can stop dementia.
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I found it useful to file a complaint with my mother's state board of insurance. The insurance company who had denied her care reversed its decision.
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Sounds like you need a second opinion and you need to file an appeal with the insurance company.
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You need provide more information please.
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Yes, more information is needed. If it has to do with medications, there may be a process through the insurance comapny for justifying the medication the MD wants to try.
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What kind of care is being denied?
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The person to be admitted must meet certain criteria. Does the criteria always make sense in real-life situations? No. That's one of the biggest problems with LTH insurance. Demenia victims lose rational thought and can't live independently, but still can make a meal or do a lot of things independently. My mom started bringing strange people walking down her street in to fix things, bought a tractor to mow her small lawn and was scamed out of about a $100k,, etc., she could no longer live alone, but met minimum "daily living" requirements according to her LTH INSURANCE. FInd out what the requirements are and I bet you can reverse the decision.
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It would help if you shared what it was/is they over-ruled. Does the co have a appeals procedure?
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Maybe get a second opinion. Find a generic psychiatrist, might help. Good luck.
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