Joseph Romano Law

An individual I represented was injured in an automobile accident. The automobile medical benefit (PIP coverage), which was the primary insurance, was exhausted. The secondary coverage was a private health insurance plan. In preparation for discharge to home, the treating doctors wrote a prescription for a "state-of-the-art" ventilator and 16 hours of personal assistant services. The health insurer would only pay for eight (8) hours of assistant services and would not pay for the ventilator prescribed by the treating doctors. The treating doctors were also of the opinion that the patient's condition could deteriorate without an "expedited appeals hearing". Usually, an appeals hearing is scheduled within thirty (30) days of the request. In most states, an expedited hearing will be granted within forty-eight (48) hours if the patient's life, health, or ability to regain maximum function is in jeopardy.

Careful planning at the time of admission of a catastrophically ill or injured patient will insure that acute care hospitals and rehabilitation facilities do not experience "discharge dilemmas".