Perhaps you’ve had a specific inpatient medical treatment—either physical or mental—denied by your insurance company. Of course, this can be extremely distressing. You pay your health insurance premiums faithfully, expecting that when and if you need your health insurance, a necessary treatment will be covered. An inpatient treatment denied by your insurance can be a major issue and one that can be difficult to resolve on your own. It can be extremely beneficial to have an experienced insurance denial attorney from the Law Offices of Scott Glovsky helping you get the treatments you need and fighting for your health and your future every step of the way.
Why Might Inpatient Treatments Be Denied by Insurance?
Inpatient treatments—as opposed to outpatient treatments—are those provided by a hospital or other inpatient facility where you or a family member are admitted and spend at least one night. When you are under inpatient care, you stay within a hospital or facility, receiving care from medical professionals like doctors, nurses, psychiatrists, and more.
Inpatient care is usually more intensive than outpatient care, usually including a minimum of three hours of mental counseling, drug counseling, physical therapy, occupational therapy, or speech therapy each day. In some cases, a patient that has suffered an unanticipated event (stroke, fracture, TBI, heart attack) or a scheduled surgery like a hip or shoulder replacement may require inpatient rehabilitation. Inpatient treatments can be crucial in helping improve a patient’s physical or mental health.
Insurers may deny an inpatient treatment for a procedural error—there were mistakes made on the forms. This can usually be corrected. The treatment may be specifically excluded under the policy, or no pre-authorization was obtained. Other times, the insurer may claim the inpatient treatment is not medically necessary, that the same results can be obtained with less expensive outpatient treatment, or that the specific inpatient treatment is experimental. These reasons may translate into “We don’t want to pay for the inpatient treatment.” Attorney Scott Glovsky can help you with this type of inpatient treatment denied by insurance.
Specific Types of Inpatient Treatments That Might Be Denied
The following types of inpatient treatments—both physical and mental—are often denied:
Physical
- Occupational rehabilitation focuses on improving, maintaining, and restoring cognition and mobility, usually with a goal of allowing the individual to return to work or to their normal life, and is often implemented following a stroke or traumatic brain injury.
- Physical rehabilitation focuses on orthopedic and musculoskeletal injuries, with the goal of restoring physical strength and mobility.
- Speech rehabilitation focuses on communication and speech as well as eating, drinking, and swallowing. Those who have suffered a stroke, TBI, or spinal cord injury could benefit from inpatient speech therapy.
Mental
Mental inpatient treatments are meant to help people manage their condition, overcome challenges, and lead productive lives. Mental inpatient treatments could be used for:
- Severe depression or suicidal behaviors
- Drug rehabilitation
- Alcohol rehabilitation
- Eating disorders
- Schizophrenia, obsessive-compulsive disorder, and other mental conditions
What Should You Do if Your Inpatient Treatment Is Denied by Insurance?
If you’ve had an inpatient treatment denied by insurance, don’t give up—there are things you can do. Perhaps the most important step you can take right now is to speak to an experienced legal advocate from the Law Offices of Scott Glovsky. While you can file an appeal on your own, the process can be difficult and complex, plus insurers are simply more likely to pay attention to an appeal when they know there is a highly skilled lawyer like Scott Glovsky in your corner.
Your doctor may need to provide a letter stating all the reasons that the inpatient treatment requested is vital for your physical or mental health and your future. An internal appeal means you are asking your insurance company to conduct a full and fair review of its decision. If your case is urgent, your insurance company must follow state guidelines for an expedited decision. If your internal appeal is denied, you can take your appeal to an independent third party for review—known as an external review. The insurance company must abide by the decision of the external review board. We recommend that you speak with an experienced health insurance denial attorney like Scott before you file an external appeal because, depending on your particular situation, your attorney may suggest you do something different.
What Insurance Companies Are More Likely to Deny Inpatient Treatments?
Although any insurance company can potentially deny inpatient treatments, some insurers are more likely to do so. According to Bloomberg Law, more than two years after California passed a law to require more comprehensive mental health coverage, health insurance companies continue to deny mental health claims, especially those that ask for inpatient treatment. California regulators reversed 65 percent of those denied claims in 2021 and 2022, while the insurers reversed about ten percent of their initial decisions. Some insurance companies in California that could potentially deny inpatient treatment include:
What About Inpatient Treatment Denied by Insurance for Drug and Alcohol Rehabilitation?
Inpatient treatment denied by your insurance can be devastating, particularly when you or a family member need inpatient treatment for drug or alcohol rehabilitation. According to americanaddictioncenters.org, in 2021 more than 106,000 people died across the U.S. from drug overdoses—almost 292 people a day. Although there is a desperate need for solutions, as many as 90 percent of those who need inpatient drug rehabilitation do not receive it. This is often a direct result of an insurance company that refuses to pay for inpatient drug or alcohol rehabilitation. When you or a loved one is facing drug or alcohol inpatient treatment denied by your insurance, attorney Scott Glovsky is ready to help you ensure the treatment is covered.
Why Would Inpatient Physical Therapy Following a Stroke Be Denied by Insurers?
If you or a loved one is struggling after a stroke, you know the recovery process can be long and unpredictable. Those who receive intensive inpatient care following a stroke recover much more quickly and have better long-term outcomes. Inpatient stroke care can help restore mobility, maximize independence, support mental health, and strengthen communication and cognitive skills. Yet these necessary inpatient rehabilitation services are often denied, stating there is no medical necessity for the inpatient treatment. You have the right to appeal this decision—and an appeal can be necessary to ensure vital treatment is covered by your insurer.
How the Law Offices of Scott Glovsky Can Help An Inpatient Treatment Denied by Insurance
Inpatient treatment denied by your insurance—whether physical or mental—can be devastating. When you are seeking justice for an unfair decision from your insurance company, you need highly skilled legal assistance. You need one person who cares enough about your case and your future to fight on your behalf. Attorney Scott Glovsky forces insurance companies to change their behavior, particularly the process of reviewing requests for medically necessary treatments. Once you speak to Scott Glovsky, you will have the truth and the Law Offices of Scott Glovsky by your side from beginning to end. Contact us today for a comprehensive review of your inpatient treatment insurance denial.