Valley man refused cover after COVID-19 battle – Community News

Valley man refused cover after COVID-19 battle

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

“He called and said they were taking him to the ICU where they gave him a ventilator,” Rachel Collins said. “I got a call a few minutes later to say his right lung had collapsed.”

She says it all happened so fast.

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

“You know, I walked down that hallway every day and thought I was wondering if I’d be walking here tomorrow because people’s rooms would be empty,” Rachel said.

Woody says he’s lucky to be alive, but when it came time to be released from the hospital, his insurer Humana rejected his claim for treatment in the rehab that his doctor had specifically recommended.

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

“If you lay down for two months and you sit up, it gets really wobbly,” Woody said.

So instead of the doctor’s recommendation for acute rehab, with access to intensive physical and occupational therapy, Humana wanted him to go to a skilled nursing unit. It would provide the same services, but with a lower intensity and a shorter duration.

Woody eventually followed his doctor’s advice to go to Encompass Health and pay out of pocket.

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

“Your insurance doctor won’t necessarily be an expert in your particular field in the initial assessment process,” Donovan said.

She says that in most cases, patients are met with outright denial and sent home. She says that if you appeal at any point, you’re entitled to an expert review and a good chance of approval.

Humana says they can’t talk directly about Collins’s situation, but say they are “weighing several factors” when considering requests for inpatient rehab centers, including “consultation 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 doesn’t acknowledge, Donovan says, is that the process can take a long time and that many people don’t realize it exists.

“As far as the appeals process is concerned, you have 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, such as misspelling your name or entering the code incorrectly,” said Donovan.

The Collins paid thousands to put Woody in rehab and he wasn’t home until two weeks later.

They also appealed Humana’s decision and it was rejected on all three occasions. They are now considering legal options.