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Where you stay in a hospital does make a difference to an insurance company.

My insurance company has a problem with my doctor in that he didn't put me in a step down unit on the second day of surgery. It just happened to be a private room that I didn't ask for. But I went home that day at 11am. Only to return to the hospital three days later for an infection. Then that became a five day semi-private room stay because of infection and painful movement.

Now insurance is fighting with my surgeon about the overnight stay. That I should have been taken to a step down unit instead of the private room.

I really don't need the stress. Anyone else going through this? My neurosurgeon practices there all the time.

One thing is different in that I am a patient that is caught up in a war between Highmark BCBS and UPMC here in Pittsburgh, Pa.

Anyone living here knows the pain I'm in and it's not my back either.
Atlasmiss [\]


  • dilauroddilauro ConnecticutPosts: 12,303
    Your surgeon needs to provide the proper justifications and rationale for their decisions. You did not pick out the floor, the room, etc....
    Insurance companies will balk about paying for things they fell they shouldnt need to pay for, tats where your surgeon comes into play and act for you.
  • I had a fabulous huge private room (with a great view) after my ACDF surgery 2 weeks ago. Just received the insurance coverage, in which it was listed for a "semi private room". I was wondering how it was considered semi-private, but I wonder if it was labeled that to avoid complications such as yours.
    Saying that, my insurance has been absolutely fantastic about everything, which I am immensely grateful for.

    ACDF w/Corpectomy C3-6 12/8/14 ; Laminectomy C3-6  5/19/2016

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