Looking for Medicare insurance guidance from the experts here.
Dad was in the hospital for 5 days with a UTI and the concomitant metabolic encephalopathy. At various times he has been unable to talk, walk, stand, feed himself or toilet himself, but he can do all of those things at baseline.
He was released to an acute rehab facility, with 3 hours/day of PT, OT and ST. While he was there, he had a recurrence of the UTI and regressed. It took several days to get him on more/different/IM antibiotics, and his 2 weeks are up tomorrow and the Medicare management company says he has to leave.
I have been trying to get the rehab place to get an infectious disease specialist to see him. That doctor is coming tomorrow. I think he should be kept here and the UTI treated, and continue to get intensive (3 hours/day) therapy.
I appealed the “eviction” and lost. He can only go down a level of care, to skilled nursing with some PT.
He is supposed to be getting immunotherapy every other week from the oncologist by infusion at his office. He was due last Wednesday, but he was in the rehab, so he didn’t get it last week or today.
There is a skilled nursing facility in the same complex where the hospital and the oncologist are, as well as his urologist. Great - he can get taken across the parking lot to the oncologist for his infusion, right?
Nope - the SNF gets one all-inclusive fee from Medicare for everything. If he has to get the infusions, they won’t take him, because it would cost too much. I can’t take him out and roll him across the parking lot to the oncologist, because they would have to pay for it anyway.
WTF?? Anyone have any ideas?
Dad was in the hospital for 5 days with a UTI and the concomitant metabolic encephalopathy. At various times he has been unable to talk, walk, stand, feed himself or toilet himself, but he can do all of those things at baseline.
He was released to an acute rehab facility, with 3 hours/day of PT, OT and ST. While he was there, he had a recurrence of the UTI and regressed. It took several days to get him on more/different/IM antibiotics, and his 2 weeks are up tomorrow and the Medicare management company says he has to leave.
I have been trying to get the rehab place to get an infectious disease specialist to see him. That doctor is coming tomorrow. I think he should be kept here and the UTI treated, and continue to get intensive (3 hours/day) therapy.
I appealed the “eviction” and lost. He can only go down a level of care, to skilled nursing with some PT.
He is supposed to be getting immunotherapy every other week from the oncologist by infusion at his office. He was due last Wednesday, but he was in the rehab, so he didn’t get it last week or today.
There is a skilled nursing facility in the same complex where the hospital and the oncologist are, as well as his urologist. Great - he can get taken across the parking lot to the oncologist for his infusion, right?
Nope - the SNF gets one all-inclusive fee from Medicare for everything. If he has to get the infusions, they won’t take him, because it would cost too much. I can’t take him out and roll him across the parking lot to the oncologist, because they would have to pay for it anyway.
WTF?? Anyone have any ideas?