Wiki medicare advantage change during a hospital stay

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deborahcook4040

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pt was admitted on 12/31/10 with QHP, and on 1/1/11 her enrollment with QHP ended and her enrollment with another plan began. An authorization for the stay was obtained through the first insurance, but not through the second - the patient was admitted with neurological issues and I think the hospital was unaware her insurance coverage was changing until she was lucid again. The DOS is 1/1/2011, so the initial insurance is denying for no coverage on DOS, and the second is denying for no auth. I've had this problem before with Medicare as the first insurance and a Medicare advantage plan as the second, and I appealed it successfully to Medicare. QHP is willing to consider an appeal, but I have to provide Medicare's policy that they pay for the inpatient stay through its entirety even if plan coverage changes in the middle of the stay. Anyone know where I could find that in writing?

Thanks,

Debby
 
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