What to do if insurance benefits are denied to a patient for their entry into a transitional living facility?

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What to do if insurance benefits are denied to a patient for their entry into a transitional living facility?

An 18 year old TBI patient is to be discharged from a rehabilitation facility after a serious car accident. He was driving someone else’s car (with permission) and the accident was his fault. The rehabilitation facility offers a transitional living facility that the doctors feel he will benefit from. The medical insurance company says the transitional living facility is not covered. Do we have any recourse? We have a PEL insurance policy – is there any possible coverage there? I would appreciate any advice.

Asked on May 10, 2011 under Insurance Law, Connecticut

Answers:

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

You need to make a big stink; make noise. Leave a paper trail. Find out what exactly and why exactly the insurance company is citing from the coverage as not being covered. Have them do the work for you. Then, while this request is being worked on by the insurance company (and it must respond to you), you need to file a complaint with the agency in Connecticut that regulates this insurance company for bad faith coverage. Further, start a writing campaign with local, state and federal representatives in your district and state and continue to push for coverage. If all of this fails, contact an attorney and sue your insurance provider for coverage and see if a court action could be brought to at least keep him there for the time being.


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