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Valley man faces insurance issues after COVID-19 battle

Posted at 5:00 AM, Nov 10, 2021
and last updated 2021-11-12 13:34:08-05

A Valley man is fighting not only to regain his strength after battling COVID-19, but he is also fighting with his insurance company to cover thousands of dollars in medical bills.

"He called and said they were taking him to ICU where they ventilated him," said Rachel Collins. "I then got a call a few minutes later to say his right lung collapsed."

She says it all happened so fast.

It was just ten days earlier that her husband Woody had tested positive for COVID-19. He was a healthy, active guy with no pre-existing conditions. However, he would remain in a medically induced coma, on the highest level of life support for the next 28 days.

"You know, I used to walk that hallway every day thinking I wonder if I'm gonna be walking here tomorrow because people's rooms would be empty," said Rachel.

Woody says he's lucky to be alive, but when it came time to be discharged from the hospital, his insurer Humana denied his claim for treatment at the rehab facility his doctor specifically recommended.

He says that denial was based on one assessment, his ability to sit on the edge of the bed.

"When you've been laying down for two months, and you sit up, things get really wobbly," said Woody.

So, instead of the doctor's recommendation for an acute rehab facility, with access to intensive physical and occupational therapy, Humana wanted him to go to a skilled nursing facility. It would provide the same services but at a lower intensity and length of time.

Woody ended up taking his doctor's advice going to Encompass Health and paying out of pocket.

Caitlin Donovan with the National Patient Advocate Foundation says this battle between patients and their doctor's recommendations and insurance companies is common.

"Your insurance doctor isn't necessarily going to be an expert in your particular that particular field in the first review process," said Donovan.

She says in most cases patients get an outright denial and are sent home. She says if you push for an appeal at some point you are entitled to an expert review and a high chance of approval.

Humana says they can't speak about the Collins' situation directly but say they "weigh multiple factors" when considering inpatient rehabilitation facility requests including "consulting with the member's physician."

They say members are encouraged to use their appeals process which includes a "review by independent third-party physician reviewers."

What Humana does not recognize, Donovan says is that the process can be lengthy, and many people don't realize it exists.

"As far as the appeals process goes is that you need to be very careful, because it's basically a legal argument you're making, and you can be denied an appeal for very minute reasons, like spelling your name wrong or getting the code wrong," said Donovan.

The Collins paid thousands to get Woody into the rehab facility and he was home only two weeks later.

They also appealed Humana's decision and all three times it was denied. They are now considering legal options.

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