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From The Appeals Desk: Readmission Denials Can Be Annoying
One health care system is suing because of it. Yet, there should be a better way
Of all the appeal letters I write for hospital partners, the ones that annoy me the most are the ones appealing “30 Day Readmission” denials. Basically, some insurers will deny payment for a hospital stay that has occurred within 30 days of a previous hospital stay and will tell the hospital, in essence, “We paid you for the previous hospital stay, and since this new stay is related to that one, we won’t pay you any more.”
It seems very arbitrary. What if the subsequent admission could not be prevented? What if something else happened that required admission to the hospital again? Some chronic conditions are so crippling that multiple hospital admissions are typical. This policy of denying an admission within 30 days of a previous one seems punitive.
Well, one hospital system in Florida is now suing Aetna over its readmission policy:
Lakeland Regional Health is suing the Aetna for more than $1 million claiming the health insurer has “arbitrarily” denied paying for patients’ medical treatment.
Lakeland Regional filed the lawsuit against Aetna Health in January, asserting the company’s refusal to reimburse the hospital for health care services it provides has caused…
