Q: Insurance denial for critical hospital stays due to high blood sugar over 1000.

A: A South Carolina attorney could advise best, but your question remains open for a week. Check the fine print on the denial and what options it outlines, whether civil suit, arbitration, appeal, complaint, or other. If you are unable to resolve, even with additional supporting documentation for the medical necessity of the services you received, and the amount of the claim denied is significant, it could worth considering a consult with South Carolina attorneys to discuss further in terms of your most cost-effective options. I hope you are okay. Good luck

A: Dealing with an insurance denial, especially after critical medical care, can be incredibly stressful. Since your doctor has confirmed the necessity of the hospital stays, you have a solid starting point. The first step is to thoroughly review the documentation provided by the insurer to understand their reasoning for the denial. Look for specific reasons given, such as whether they believe the treatment was not urgent or whether they have questions about the nature of the treatment provided.

You can appeal the insurance company’s decision by submitting a formal written appeal. In this appeal, include a detailed letter from your doctor confirming the medical necessity of your hospitalizations. It’s helpful to also include any test results, medical records, or other documents that show your blood sugar levels over 1000 and the immediate need for treatment. Be sure to reference your policy and any language that supports your case.

If your initial appeal doesn’t resolve the issue, consider reaching out to your state’s insurance department for assistance. They can guide you through the next steps and may help you advocate for a reevaluation of your claim. In some cases, hiring an attorney who handles insurance disputes can also be beneficial if the appeal process is lengthy or complicated.