Need Appeal Letter Assignment Help: How to Answer This Question

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Original Question

I need an appeal letter for a medicare advantage insurance denying inpatient rehab even though the patients acute doctor ordered and recommended it, did a p2p for her to go (and it was still denied) and then was told by the denying md from the insurance that if patient appealed. “She would just deny that too.” This is not fair to have the same md on prior auth request for appeals and not ethical. This patient is not at her max function and is unsafe at home with home health services and her needs would not be adequately met at a skilled nursing facility. All the supporting clinical documentation at acute justifies and shows her need for acute inpatient rehabilitation. The physicial therapist even addresses that inpatient rehab would be the most beneficial route for her to regain max independence due to her significant endurance issues from this hospital stay. This patient is barely able to pull up her own brief safely without assitance due to endurance limiations or open a carton to prepare food. Her spouse with her is not able to support her physically and would be very unsafe. Patient is only able to ambulate 45 feet with supervision and a roller walker and would desperately need acute pt to improve functional mobility because this hospitalization has exacbervated old cva symptoms. patient is on plavix with a history of stroke and coronary artery disease, a pacemaker and multiple cystic lesions in the body and on the tail of her pancreas she is status post EUS with evidence of mixed type IPMN/main duct IPMN and was admitted for planned RA distal pancreatrctomy with spenectomy which requires specialized medical oversight while getting the therapy she needs. This patient is at a critical juncture in her recovery and to avoid another hospitalization acute inpatient rehab has been recommned by her doctors and team at acute for maximum recovery. Denying this patient this is a huge injustice to her overall wellbeing and health. The 3 hours of therapy is a therapeutic approach and tailered to her needs at in patient and she also needs the comprehensive rehabilitation team at acute to Facilite a safe discharge back to her home.

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