How do I appeal my mother's HMO's decision to cease funding her care?

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My mother had total knee replacement on 11/20/09. She was then transferred to a nursing home for physical therapy on 11/30/09. It has been 3 weeks and her HMO wants her to be released on 12/18/09. The problem is: Mom isn't able to walk without assistance. I am appealing it and hope something good happens.

I find it so hard to believe that the HMO will stop funding for my mother, who is still very dependent on help from other.

I was told that if the appeal is denied, she would have to pay out of her SSI income.

Has anyone ever experienced this situation. If you have any comments and ideas, please respond.

My husband and I work and we can't care for mom. She has 3 hours of IHSS.

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Expert Answer
3930 helpful answers
Unfortunately, this is not uncommon. Many insurances give people so many days of therapy and that is it. If you aren't okay - too bad. I'm really sorry you have to go through this.

One thing you may want to look into, since she's on SSI, is if Medicaid will cover some in-home services. Other than that, I'd go to your state's Web site and find aging services. See what they have, or call the number. They should be able to direct you to local help.

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