Did case manager's misinformation delay care for my mother after cerebral hemorrhage?

Question

My mother suffered a cerebral hemorrhage and was hospitalized for a week. The hospital's doctor and case manager recommended an inpatient facility for her off dexterity and balance issues. We selected a facility that was said to be within her insurance network, but her application was denied. The case manager claimed the denial was due to her improvement, but the insurance stated the facility was out-of-network. Consequently, my mother has worsened; she cannot hold anything with her left hand and struggles to stand without falling. Was the case manager's misleading information a factor in delaying her care and worsening her condition?

Tim Akpinar · Answer

A Tennessee attorney could advise best, but your question remains open for two weeks. I'm sorry about your mother's ordeal. This will probably require investigation to validate the basis of denials, both from the case manager and insurance carrier. If the facility was truly out of network, that could diminish the basis for a claim that relies on damages stemming improperly denying admission. This will probably involve a review of patient records and insurance policy conditions. I hope your mother is okay. Good luck

James L. Arrasmith · Answer

Yes, the case manager’s inaccurate statements may have directly contributed to the delay in your mother’s post-hospital care. If you were told that the chosen facility was in-network and that her application was denied due to medical improvement—when in fact it was denied for being out-of-network—then your family was misled at a critical time. That misinformation likely prevented you from immediately seeking approval for an alternative, covered facility, which may have worsened your mother’s physical condition. 
 
Hospital case managers are expected to provide accurate and timely information when helping patients transition to follow-up care. If their guidance is incorrect and causes harm, that can raise serious questions about the standard of care and potential liability. In your mother’s case, the delay in proper rehabilitation support may have resulted in preventable deterioration, especially after a neurological event like a cerebral hemorrhage where timely therapy is essential. 
 
You should gather all written communications, discharge paperwork, denial letters, and notes from your conversations with both the case manager and the insurance provider. If your mother’s condition was made worse by delays caused by this misinformation, you may have grounds to raise a formal complaint with the hospital and explore legal options. You’ve done the right thing by asking questions and seeking answers—your mother deserved clear, truthful guidance when she needed it most. Stand firm and demand accountability for the care she was denied.

Q: Did case manager's misinformation delay care for my mother after cerebral hemorrhage?