VA Medicaid Coverage Denial

i’ve been in the hospital for roughly 10 days now. I got what was supposed to be a same day procedure that went well, but the pain and inflammation flared up my arthritis. especially in my hips and knees and now i can barely walk. I need help with nearly everything (in/out of bed, on/off the toilet, getting dressed, bathing, walking) and i have a very intense pain management regimen but unfortunately still at a constant 6-8/10. My doctors want me to transfer to an Acute Inpatient Rehab Facility and all we were waiting for was insurance approval… unfortunately i was denied for the reason of “not medically necessary, do outpatient PT 3x a week.”

Unfortunately for me I live alone in an apartment building on the 3rd floor with no elevator… which means i would have to walk or drag myself up 3 large flights of stairs to even enter my home, let alone be able to care for myself when i’m actually inside of it. My boyfriend only has 1-2 days off per week but other than that he absolutely has to work and cannot call out to take care of me 24-7. I don’t have any other home to discharge to or anyone else who could care for me.

I submitted an appeal over the phone today and my doctor will be doing a peer to peer review phone call tomorrow.

I’m scared and don’t know what to do if this doesn’t get approved. My physical therapist team here in the hospital said to think about a Skilled Nursing Facility which might get denied too.

Any tips would be greatly appreciated.