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The initial approval of a claim is commonly done by somebody without medical training. The patient in this case should/will appeal, and will get his doctor to support his appeal. If that doesn't immediately work, he should/probably will contact the press, local TV station, etc. and let the insurance company know this is what he is about to do.
He will win his claim very quickly, assuming there was a legitimate, unpredictable reason he was 6 days in ICU.
It is not cost-effective for a trained medical person to be reviewing every single claim. So guidelines are set up, which cover most cases. If you have one of the outlying cases, you have to go up the food chain a ways, but the system basically works.

Best wishes, Chris
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