A representative from a privately owned seniors’ care home explained that despite Health PEI pre-approving coverage for exceptional health care costs for a resident, that coverage was declined after the services were provided. The home explained that while the care was administered within the period Health PEI agreed to cover related costs, the third party healthcare provider submitted its invoices to the home after the period ended. When these invoices were submitted to Health PEI for coverage, Health PEI explained that the costs would not be covered due to the invoice dates.
We contacted Health PEI to ask what happened. It then reviewed the matter and concluded that it had made a mistake in not covering the costs. It explained that staff transition during the invoice review period led to confusion about what had been pre-approved. Acknowledging that the costs had, in fact, been pre-approved, Health PEI provided coverage to the private care home and apologized for its mistake.
