CrysLednum
Guru
Hi - We have a surgeon who was on-call and admitted an older patient who had a dislocated shoulder. The reason he decided to admit was that the patient's "social situation" would not enable her to be cared for.adequately. Federal BCBS is the carrier and they are denying as not medically necessary. I had thought that if there is a reason (medically) and I also believe that if a patient is at risk for not getting the care she needs that this is an arguable/winnable case. However, our appeals person just informed me that it is still being denied. Any ideas on this one? Thanks.