Have you ever had insurance payment refused? - Alzheimer's Disease & Dementia Message Board

Martha H · 10-20-2008, 07:40 AM

This subject came up because my daughter's insurance company is refusing to pay for her treatment, MRI etc, thinking they can blame the soccer accident on someone else and let them pay for it. The surgery is tomorrow.

But as it relates to Alzheimer's ... when my Mom fell down the stairs at age 96and broke her hip, and was taken to the hospital in an ambulance, both Medicare and her supplement at first refused to pay for her medical and surgical treatment. They said that since it was an accident, a third party might be found to blame it on.

She fell in the home where she was living, on a staircase, in the dark because she herself had turned out all the lights. Wandering at night in her demented state.

My brother had mountains of paperwork and endless phonecalls before the two different insurances finally agreed to pay for her care. What a hassle.

We pay them good money for these services, and when we need them most they give us a hard time.

Has this happened to you also?

Love,

Martha

quetzalmom · 10-20-2008, 09:42 PM

I've had similar situations, but never had an insurance company not pay because they wanted another party to. They always paid and I provided the accident details. They were free to recover their money from the other entity should they choose to do so. No one ever suggested I get the money from someone elso, I just had to give my company the right to do so if they wished.
Q

Gabriel · 10-20-2008, 11:19 PM

I'm with Q. Even when Mom fell and broke her leg at a local establishment that was obviously negligent, the insurance paid..... they were reimbursed by the company eventually. Both times Mom fell recently, breaking her arm and spraining her neck, they didn't even question the bills.

It may have to do with your location and the insurance regulations there. Your state probably has an insurance commissioner or the equivalent. I would definitely call the office and see what they can tell you about your state.

I do hope your daughter does well tomorrow and is home recovering quickly. I will say a special prayer for her tomorrow and keep you both in my thoughts and prayers in the upcoming days.

Love, deb

Martha H · 10-21-2008, 06:37 PM

She got through the surgery OK. She took longer to wake up than expected -- maybe because none of us believe in pain meds and thus react more strongly to them when we do get them. She is at home now, resting, with an ice-device around the sore leg. An incision was made in her thigh to take out a piece of her hamstring ligament to transplant into the knee. She came home using crutches and lying down in the back of her husband's car. Cannot put any weight on that foot yet. Friday I drive her to the hospital for a checkup and therapy. Thanks for all your prayers!

Love,

Martha

DrewsG · 10-21-2008, 06:49 PM

Glad the surgery is over. It sounds very painful. I hope everything works out for both of you. Take care of your baby Martha and yourself. I'll be thinking of you both.
Love Chris