Need Medical Appeal Assignment Help: How to Answer This Question

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Key Explanation

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Original Question

I need a medical appeal letter for a denial from insurance with factual evidence showing that this denial from my patients insurance was inaccurate. The denial stated the member did not meet the medically complexity for inpatient acute rehabilitation and the care she needs are more appropriate for a lower level of care such as a skilled nursing facility (nursing home) , however this patient has MULIPLE comorbidities that cannot be properly or SAFELY managed at a lower level of care such As: CHF exacerbation secondary to Cardiomyopathy Adenocarcinoma of the cecum status post right hemicolectomy and ileostomy Previous GI bleeding status post EGD and colonoscopy (found with large malignant appearing mass filling the cecal cap with serval small polyps in the ascending colon in additional to a rectal polyp removal. Patient has been experiencing pain and weight loss for over a month before all of this and desperately need the adequate continued patient education to improve her future. A CT on 03/14 that showed a small to moderate right AND left pleural effusion with right upper lobe nodule 9mm in size. Significant cardiomegaly with mild pericaidal fluid CT abdomen showed cholelithiasis with gallbladder distention and wall thickening patient needs a medical facility able to provide the oversight and medical intervention she may need following her elevated platelet rise, the acute provider are Strongly recommending inpatient acute rehab as not only the safest option but the best option for this member to prevent another long hospitalization and have ordered inpatient rehab as the best option for the patient. Prior to this hospitalization this member was independent and now requires a roller walker due to the significant medical issues she has experienced, and inpatient level of care is the only care appropriate enough to oversee her conditions while building muscle strength and endurance to achieve max level of function and also needing oversight of a rehabilitation doctor to prevent further injury and another long acute hospital stay. This member goal is to get back home and sending her to a skilled nursing facility where they do not have the medical personal would gravely impede her ability to do such. This member needs physical therapy and occupational therapy to be able to ambulate again independently, perform basic ADLS such as opening a carton for food/preparing meals for herself, showering/bathing herself and to show functional improvement to maintain a moderate activity level.

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