Picture this its the middle of a covid surge in South Florida, hospitals and nursing homes are not allowing visitors, when I get a call that my grandmother has fallen and broken her hip. She was admitted to a hospital about 45 minutes away and underwent successful surgical repair. She got through a few post op complications and was working well with the therapy department. Once she was medically optimized I requested for my grandmother to be transferred to my acute rehab. To my horror her insurance denied acute rehab citing ” medical necessity”. As you might of guessed I was outraged, especially since her insurance was trying send her to a sub acute rehab where she would not be allowed any visitors and also receive less therapy and medical attention. Here is the exact copy of the letter I wrote insurance:

Attention: Expedited Appeal

To Whom it May Concern,

I am writing as a physician, concerned family member, authorized representative. Unfortunately my grandmother, Mrs. Maurer, fractured her hip and is currently at (name of hospital). Her course has been complicated by anemia requiring blood transfusion, acute urinary retention, new onset afib with rvr, and encephalopathy. As a board certified physiatrist , I know 100% that the next best level of care is at an acute rehabilitation facility. Mrs. Maurer has multiple medical problems requiring close supervision and is able to tolerate three hours of therapy a day. I have personally reviewed her progress with skilled therapy. Mrs. Maurer was completely independent with her mobility and ADLs prior to admission. I believe a SNF level of care will be death sentence for her as she is hard of hearing and I fear her mentation will worsen if not able to have the close medical supervision and family member support. As you know the skilled nursing facilities in South Florida are not allowing outside visitors secondary to the Covid Pandemic. As a physician in the area who works at a local acute rehab where she can get the care she needs I am appalled by this discharge and with the medical director Dr. XXXX who has refused to discuss the case with me. Frankly, I currently have her same insurance members with less medical necessity on my acute rehab service. As her family member and authorized representative, I am asking you to reconsider the discharge disposition and help me save my grandmothers life. Please call me anytime to discuss at: xxx-xxx-xxxx.

Thank you for your time and consideration

I wish I could say she was immediately transferred to my rehab. But sadly the hospital kicked her out to a nursing home before the appeal decision. Three days into her nursing home stay (which my grandmother has yet to receive any rehab) the decision was over turned and was approved for acute rehab. So my grandmother was uprooted again and transferred to my rehab where she got the care deserved and was successfully discharged home.