UT Health East Texasprolonging stay at hospital

B Jul 03, 2019

My mother was transported to your facility from Quitman on June 18, 2019. It is July 3, 2019 and due to attending not responding to her Insurance Provider on June 26th her case was denied for her to be placed in rehab. Also, the report insurance received was that she was only suffering from pneumonia. This ailment is the least of her worry and isn't why she was admitted in the first place. She had Diabetic Ketosis - Acute Pancreatitis -UTI - Sepsis and her lack of mobility in doing things without assistance. I requested as well did case manager she go to Rehab and possibly long term care due to her cognitive function with memory issues and the need for assistance in getting around. I was informed by Tyler Hospital Monday July 1st that Dr. Johnson had called and spoke to insurance but found the case was closed. I was told Tyler could do nothing regarding this and that she would not be able to stay while an appeal took place. I explained the reason it was denied was no fault of the insurance or my mother, but your facility in not responding to the Peer to Peer on the 26th of June. I also spoke to her other doctor [not sure name, but was foreign] that he had not gotten a request from case manangement of a Peer to Peer. I also speak to different Case Managers due to someone being out and someone taking over - maybe here lies the problem. It is apparent someone is dropping the ball and causing this from your facility. My mother is becoming depressed and begs me to take her home which I cannot do as I am not a licensed nurse and cannot care for her health related issues much less try and assist her in getting around. She deperately needs rehab and be in a skilled nursing facility for her safety and well-being. Please for her sake and her family respond to the insurance correctly and in the time they requested so she can be moved. I filed an appeal on July 1st and see that today it is pending in the naviHealth system. I am very concerned since the up-dated diagnosis still did not list the Diabetic Ketosis nor her lack of mobility without assistance. How difficult is it to provide all health related issues she was being treated for? Why are we still trying to resolve this? Who does the family speak with to get this matter taken care of once and for all? What happens if UT-Health Tyler drops the ball again and it's denied? I have placed a call into Adult Protective Services and have all the documents I've sent and ones from naviHealth. At this point I'm not sure what to do, but will try my best to ensure her health and safety are looked after. Please respond and let her family know what is going on. Her name is DOLLY K. SMITH - rm#3339

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