Q: I have Aflac and was denied accident, hospital and critical illness claims after I have a miscarriage at 12 weeks.
was hospitalized( was admitted), and given an emergency blood transfusion. Was this not an accident? Is needing a stat blood transfusion critical? And I was admitted to the hospital but because I wasn't there 24 hours they denied that claim as well?
A:
A Pennsylvania attorney could advise best, but your question remains open for two weeks. And it's possible that time could be of the essence in responding to the denial. I am very sorry for your ordeal.
The short answer is that an attorney consult could be valuable here, unless you are experienced in dealing with healthcare denials. Review the denial carefully and see what your deadlines for responding are, and if options are outlined - in terms of reconsideration, appeal, file for arbitration, file civil suit, etc.
I'm sorry that it isn't possible to offer meaningful direction beyond that. An experienced attorney would need to review the policy, its definitions, your patient chart, etc. The physicians in the hospital could be your allies here, if it turns out to be a matter of relying on them to attest to the medical necessity of the procedures administered.
These are only some general points. A consult with a Pennsylvania attorney versed in health care claims should be able to provide more detailed and specific guidance. I hope you are able to resolve the matter. Good luck
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