Do NOT get insurance with Clover for the Elderly!
My mother broke her hip and fractured her back during a fall and she needed hip surgery. She was covered which was fine. The hospital sent her to a PT rehab, where she would get the recoup she needed. The center was ok, there were quite a few hiccups in the facility, but our family managed to iron them out. When Clover decided she didn't need treatment anymore, my brother filed an appeal for it. They denied it, their reason, "She can walk 150ft with her walker and assistance. She can do things with assistance but she is fine to go home". So if anyone else see the contradiction there, you would know, we weren't ok with it. I called Clover where the representative stated that it wasn't Clover who denied it, it was Medicare. So I called Medicare, they said it was the insurance decision but if I wanted to appeal it, go to this department of appeals. Called them, filed an appeal and was told to call another number to file an emergency appeal. Meanwhile, as I'm on the phone, the nursing staff is packing up her room getting ready to bounce her to their lobby or dining room where she would have to sit for 3+ hours until a family member could pick her up. So I then spoke with the social worker at the place, got into a spatt with them and they said to duke it out with Clover because they are the ones who made the decision. So I called Clover back and argued with the representative and at that point I was very frustrated. The representative could not explain anything, had no idea of anything, of we asked him to define what it means when they put "she needs assistance but she's ok to go home", the representative could not explain it. I had gotten my sister in law on the phone and we tagged team basically to get this representative to understand that she could not go home. We fought him for an hour and a half until he finally ask if he could speak to the doctor. So my sister in law got the director of physical therapy and the doctor himself on the phone, after another hour, the doctor explained that she was not ready to go home and she need to remain in the facility for sometime yet. The representative then said "ok, now that I spoke to the doctor, what I can go ahead and do is give it another week for your mother to stay at the rehab while the doctor fills in the paperwork to submit to us for the stay". We felt relieved and thought everything was good. We then get a call the next day stating that her appeal was denied and she has to go home. I called Clover back up and was furious to the point I was screaming at them. They got me a supervisor who said that we had to talk to their 3rd party appeals team called Commerces. They are the ones who make the decision on a second appeal because Clover says they don't want to be the bad guys when it gets denied again (basically in so many words). So I filed another appeal and we were told we would get an answer over the weekend, but meanwhile, my brother and his wife paid for a full weekend of $605 a day for her to stay while they made their decision. They denied her again. So Monday came around and the supervisor called me back and I ripped into him again. Explaining everything all over again to him about her staying the week and waiting for the doctors paperwork. Turned out that the social worker sent the paperwork to two different fax numbers as they requested and when they called to find out about the decision Clover said they didn't get anything. So the social worker faxed it a third time to another number. When I said this to the supervisor he kept saying "I don't see anything from the doctor" so I kept pushing him and pushing him. He then said, do you have it in writing that we stated that she could stay for another week while the doctor gets us the paperwork? I said no we have it recorded. He then said we'll I can't accept a recording, I said fine then go play back the recording from the other day, since you guys record your conversation and you'll hear your representative grants us the week. He said he could not do that as he didn't have the authority to, I said then he should be fired. So he wanted to get in a pissing match with me and it got to the point that he called commerce to get on the line with us for what reason I don't know because Clover is the one making the decision. Which the guy at Commerces said too, I told the guy, I don't know why he dragged you on the call to tell me something I already know. He also stated that clover can grant 20 days for recovery but they don't have to give you the full 20 days, they can cut it when they seem fit. Good insurance huh? So the supervisor went and spoke with his prior authorization team and said the first person said no immediately so he called another person and they said they would investigate with the facility. Meanwhile my mother had to come home with no PT and she has to lay in bed now. Clover is the worst insurance company. I would never recommend them!
By Rich C.