If you need inpatient rehabilitation after a hospital stay, sometimes the path to approval isn’t a straight one. Here is some helpful information on how to navigate an insurance denial appeal depending on which step of the process you are facing.
If you will benefit from inpatient rehabilitation, a liaison or case manager at your current hospital will start the initial authorization process with your insurance company for admission to the rehabilitation facility (e.g., Good Shepherd). This authorization process takes approximately two days. A Good Shepherd liaison will reach out to your hospital case manager to arrange for admission to Good Shepherd.
Family or Expedited Appeal FAQs
Is a Family or Expedited Appeal Worth the Effort?
Although this level of appeal can take 3 to 10 days to complete, it can be successful even when the doctor’s appeal is not. Typically, the Family or Expedited Appeal goes to a new doctor, who might see the situation differently and agree to the inpatient stay.
Will I Stay at the Hospital During a Family or Expedited Appeal?
This can vary. If the insurance company will not pay for you to remain in the hospital during the appeal, you may be discharged to another type of non-acute facility temporarily. If this appeal is approved and you have already moved to a non-acute facility, arrangements can be made to transfer you to the higher level of care at Good Shepherd. If your Family or Expedited Appeal is denied, you likely must remain at the non-acute facility to complete your rehabilitation stay.
For additional information, please call 1.888.44.REHAB (73422).