can insurance refuse to pay

[loveldy37]

We are in California. My father has had parkinson's disease for the past 17 years. He has become very ill and unable to swallow liquids without it coming out of his nose and into his lungs. He has had pneumonia 3-4 times in the past year. He is 100% dependent on pysical help. He can do nothing for himself. He is now in a skilled nursing home after having a PEG tube placed. His insurance has paid all they will through 9/5/00 from 8/18/00. We want him to move into our home and we want to take care of him. His insurance company says they will NOT pay for his medical bills any longer if we decide to take him home and he gets ill again. They say it is against medical advice. He WANTS to be home when he dies. He knows he may never get any better. He hates being where he is. Our family wants to do all we can do for him and keep him happy. We know we can be taught to do what needs to be done for his PEG tube. Why will insurance pay for my dad to be in a nursing home, but won't pay for someone to come help take care of him at our house while we work? During all of this with my father, my mother was put into a psychiatric hospital. She is diagnosed with a psychosis and is now on Haldol medication. She cannot live alone again either. We are lost. What do we do and do we have any rights as far as if our dad comes home and he dies?

[This message has been edited by loveldy37 (edited September 02, 2000).]

 

[I AM ALWAYS LIABLE]

<BLOCKQUOTE><font size="1" face=" Arial, Verdana, Helvetica">quote:</font><HR>Originally posted by loveldy37:
My father has had parkinson's disease for the past 17 years. He has become very ill and unable to swallow liquids without it coming out of his nose and into his lungs. He has had pneumonia 3-4 times in the past year. He is 100% dependent on pysical help. He can do nothing for himself. He is now in a skilled nursing home after having a PEG tube placed. His insurance has paid all they will through 9/5/00 from 8/18/00. We want him to move into our home and we want to take care of him. His insurance company says they will NOT pay for his medical bills any longer if we decide to take him home and he gets ill again. They say it is against medical advice. He WANTS to be home when he dies. He knows he may never get any better. He hates being where he is. Our family wants to do all we can do for him and keep him happy. We know we can be taught to do what needs to be done for his PEG tube. Why will insurance pay for my dad to be in a nursing home, but won't pay for someone to come help take care of him at our house while we work? During all of this with my father, my mother was put into a psychiatric hospital. She is diagnosed with a psychosis and is now on Haldol medication. She cannot live alone again either. We are lost. What do we do and do we have any rights as far as if our dad comes home and he dies?<HR></BLOCKQUOTE>

My response:

You have every right to take your father home with you if that's what you and your father wants. The insurance company, on the other hand, has a right to withhold payments on the policy if being away from a Health Care Facility negates their obligation to pay. You need to have the insurance policy reviewed by an attorney to make sure that is what the policy requires and mandates.

IAAL



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[peter]

Its a sad situation....but thats what you get when someone else pays the bills.

You can ALWAYS take him home, but YOU will have to pay for everything.

Consider selling his home for the cash, or using up his life savings, really not much you can do.

Maybe you could try and see if you can get a waiver To NEVER EVER EVER to sue the hospital and Insurance company, and then have him come home and they pay..

Its worth a shot