1 Jan, 2018 → by ClaimboUser860794
denial of healthcare services

1

Texan Plus is the worst insurance available. You receive better care with absolutely anyone else. This is the third time I've attempted my complaint. The Texas Insurance Board is also receiving a complaint about you. My Mother (Elvia Witt DOB 10/28/31) has requested that I complain about her horrible insurance. As POA and daughter of a completely independent person, I begged her to change back to straight Medicare for future use. Texas Plus is only good when it's not used. In October if this year she had an Ischemic Stroke and was denied Acute Inpatient Rehab which she has clear Medical necessity which was recorded and given to you and Appealed twice. The last appeal didn't even get a response. Since the stroke she has continued living alone but gave up driving. Last week she fell and has a fractured hip. Surgery was completed last Wednesday and as expected a denial was received yesterday. I started an Apoeal yesterday. She needs this Acute Rehab right now without further delay. If she had not been denied her right and need for Rehab in October she would not be in this position now. Without Acute Rehab her independence will be tragically limited. This is a real problem with Texan Plus. I've been a nurse for over thirty years and a Case Manager/Denials Manager for over twenty. Do not insult me with Medical Necussity or Medicare Regulations, I've tauhht many classss on them. You have received clear records this time as well as in October. Here's hoping your mother is not treated in the same agreeous manner that you have treated mine. At this time you will need to overturn the denial for Inpatient Acute Rehab. Otherwise I'm delighted to spread the word about Texan Plus to any media willing to print or listen. As the board looks into not only my complaint but others, hopefully they will curb your behavior or better yet close your doors.
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