My mother in law is in a nursing rehab center for a broken ankle and hip but insurance is refusing to pay. Any advice?

Jan 25, 2012

You can probably appeal the denial on the grounds that she stil qualifies for PT for strengthening her legs/preventing loss of muscle strength and mobility, enable safe transfers, etc. She rpobably meets rehab criteria as long as there are functional goals for both PT and OT that can be acheived despite not weightbearing on the legs initially. They don't necessarily TELL you can appeal, let alone how. Admissions coordinators at the facility should help you with this process. Plesae let us know how it turns out! I suppose the alternative is to arrange a lot of in-home therapy serivces, and some insurers don't cover that very well either. Do your best not to let them get away with unreasonable denial of service. It really should not be this hard!

shannon1

Jan 25, 2012

Thank you so much for your response on this! They actually did say that she could put in an appeal and in a round about way said it will probably not get approved. We will definitely try this route along with applying for Long Term Care and see what results come out of it.

Reenie

6 days ago

My 84 year old mother broke her ankle and can't be on for 2 months. She needs rehab to learn to transfer with her good leg. No rehab will take her and she does have insurance that will cover 100 days. They say she would be Medicaid pending. Is there anything I can do.

vstefans

5 days ago

Reenie, that does not make sense! Having 100 days sounds like Medicare and why would she be "Medicaid pending" if she has Medicare? Is there a lot more going on besides the borken ankle, such that they do not think she will be able to accomplish any rehab goals? I'm not aware of many facilites that don't take Medicare...Do you have any options to have therapy for her at home? Where is she right now?

jeannegibbs

4 days ago

Huh? She has insurance that will pay for 100 days and the rehab place won't take her? Many rehab facilities (TCU) are within nursing homes. Does the facility think she is applying to live in the nursing home? This is very confusing.

Reenie

14 hrs ago

I agree that this does not make sense . The rehab places that evaluated her said that there afraid she will run over the 100 days and then she would be Medicaid pending to pay for her care . They don't want to risk it because once she is there they can't make her leave. They are assuming the worst case . It's seems it's all about the mighty dollar . There should be some kind of law to protect people from this. My mom needs to be in rehab to get stronger and learn how to transfer from lift chair to a commode because she is a heavy women and me or my dad can't lift her