Follow
Share

My mother has Medicare and secondary insurances. Her 100 days are used up.

This question has been closed for answers. Ask a New Question.
We r living too long. Years ago by the time people turned 65 most parents were gone. I don't want to be my Mom. She has no life. She can't walk w/o a walker and can't stand for a length of time. If we take her to the Mall its in a wheelchair. You can tell she doesn't like it. She was an advid reader. Not now. She complains about her eyes, there is nothing wrong. Its all the dementia. Otherwise she is healthy. Is it fair that she could live like this for years getting worse.
Helpful Answer (0)
Report

It is such a sad thing for America (and the human race) that we do not take care of the very people who built this country. They paid taxes into SS and everything else for 50 years, and now, when they are helpless, they are expendable. It isn't that unusual - UK does little for seniors when they are ill and if terminal just give them pain pills, no treatment. Those who have not saved a huge fortune are at the mercy of whatever is there. It scares me - and to make it worse, if you have saved in 401k and take it out for medical care when you need it - the government takes its taxes out of it - so you don't really have what you think you have in retirement savings. Sending you hugs, I hope you can get some help for your mom!
Helpful Answer (0)
Report

Eik - you mention that "mom cannot work".
So is it the situation that mom is not elderly & in her 80's or 90's?? - I assumed that she was elderly as that is the situation for most of us on this site, followed by spouses who have their mate with dementia. Is she in her 60's and still working? Is she on usual Medicare which is for those 65+ or did she qualify for special circumstances Medicare (like they do for dialysis and some other issues) so she is younger than 65 but gets Medicare?

What were the circumstances that led her to hospital and then rehab?

You mention a hoyer-lift, is it the situation that mom has no ability to walk or move herself from bed to chair/ bed to toilet at all? Is mom a large lady? Is she needing to be log rolled onto the sling and is it anticipated that will not change? Is the rolling able to be done by 1 person or is the rehab/NH having a 2 person team doing it?
Helpful Answer (0)
Report

Poorly run facility. You could have had ur Mom transferred. I would call Medicare. If they r no longer paying, then the person needs to be released. OT, PT can be done at home. Is what ur Mom has life threatning? If so, maybe Hospice in the home. If she is put with a homecare facility, they can evaluate. Talk to the doctor associated with the facility. If u get nowhere, call her primary and ask that he talk to the doctor. Anytime one of my parents have been in rehab, the Social worker handled everything.
Helpful Answer (0)
Report

Thank you. However no discharge planning was done. This facility treats people with no respect. I am trying to keep my mother spirits up while the so called social worker finds someone to evaluate what she needs at home. Also my mother cannot work and will have to have in place hospital beds and health care aides in place before leaving facility. She is presently thete. I am disputing the things that were not in place for a safe discharge. She will requite 24 health care.
Helpful Answer (0)
Report

Also I'd like to add, it's good to take a step back and realize what the government / Medicare has paid for mom in rehab. Like - Jo Anne I'm going to use your info - ok?,! - the first 21 days Medicare paid the facility $ 760 a day for room & board. Atop that Medicare paid vendors (pt, OT, rehab doc, etc) for their services as per Medicare agreement rates. $ 760 x 21 = $ 15,960 r&b Medicare benefit paid for alone! Then add 80% medicare paid of days 22-100, 79 days @ 80% or $ 608 a day. That's 48k. If my #'s are right, it's a huge staggering sum of 64k the program has spent on mom at a minimum just from this rehab incident.

$ 64,000.00 just on rehab paid by Medicare. Add hospitalization, it's over 100k

The costs are staggering. The facility just has to know that somehow they will be paid by the resident or their family. Often for post hospital rehab stays, the facility if the resident does not have a secondary policy or the secondary policy is puny, will overlook or discount the 20% due as 80% is paid by Medicare. ( like they accept whatever not the full 20% paid by a crappy insurance policy) If this facility has been doing this for mom, they may have run out of financial ability to discount moms stay any longer.

The PT is likely frustrated with you as from her perspective mom is at 100 days, no progress and at plateau. PT may have already gone past the limit to extend mom to her 100 days too - they do have a bit of discretion on evaluating progress. But if rehab is flat not gonna make a difference, that's the reality. If mom is at her 100 max, Medicare is done. Mom needs to find a way to pay to stay or you move mom back home with you or other family.

Aging in America is not pretty. And likely not to get better as costs increase.
Helpful Answer (0)
Report

Mallory - for my moms rotor cuff & PT &OT add on, it was about 10 yrs ago & centered on post surgery codes to get first 100 & then a round 2 on different code. Mom had high option federal BCBS so no cost to her ever. It makes sense that this has been limited now as much is a duplication of services.

Eik - the 100 days is standard Medicare rules. Sometime within the past 100 days there have been care meetings regarding mom where her status was discussed. Your mom has gotten all sorts of info from CMS and probably also her secondary insurance that details benefits over the years. Mom and her POA have the responsibility to know this or ask about benefits. If mom has had her 100, platuead and not progressing, there is no more rehab Medicare benefit paid for the incident. Appeal IMHO is a waste of your energy.

The facility has to do whatever to ensure they will be paid. It's a business and until mom has established qualifying for Medicaid, she is not established to be financially at need.

If you don't do something to work this out, they will likely do one of these:
"30 day notice" to mom, you, & either APS or Area on Aging; ask the court to do an emergency ward of the state action; or if mom has psych issues Baker Act her; or you or mom if she is is competent may have to sign off an admissions agreement or contract; or mom applies for Medicaid. Medicaid " pending" admissions usually require the facility reviewing the documents needed so they can determine if they will accept mom as a "pending" resident. Both for my mom & my MIL, the NH (different ones too) reviewed the needed by Medicaid documents first to see if they would accept them as pending. If something seems not ok, they can require an admissions contract be done to have them as pending

Whatever the case, the facility at a minimum will require that mom pay or turn over whatever monthly income she gets - her SS, retirement. Whatever income that issues an annual award letter (SS & most federal, state retirements do these). The awards letters will be needed for the Medicaid application too. If mom has any non exempt assets over 2k, she will have to spend down before Medicaid will approve & pay.

It is going to be easy to be very overwhelmed in all this. Try not to take things personally or be peeved with the facility. The rules are strict and exacting on all this. Good luck.
Helpful Answer (0)
Report

Eikooc251, yes God is real, and I believe there are Angels at work all around us. But we have to do what we can, too. I am not on the East Coast, sorry, but I will continue to remember you in my prayers. I pretty much pray all day long, and at night too (since I hardly sleep thru the nite anymore!).
Helpful Answer (0)
Report

After 100 days you pay. Not sure how a supplemental would work. You should have been told this going in. After 21 days they don't payfully. Mom owed $152 a day for th rest of her stay.
Helpful Answer (1)
Report

Malloryg8r. Thank you for your time and your head ups. I continue to also pray. My faith and my mother's faith is strong
Karma is real. I have to protect my mother at all times? Are you in NY? I live in NJ and rehab is in NY.
Helpful Answer (0)
Report

Eikooc251, I am so sorry to hear of the troubles your mom has had, and all the seemingly endless paperwork, plus the additional burden of possible personal injury claim. I hope you find a competent law office, remember they will usually give a free initial consultation. One hint, keep a running journal of everything you are doing, out of the ordinary, towards your mom's care. When someone calls, reach for your notebook before you pick up phone. Ask them to identify their 1st & last names and spelling and their position & phone number. Write time/date. If any action taken after phone call write that down too. Document what was said in pH cls with a followup email or snail mail letter. Etc etc. Don't rely on your memory. I also will text myself brief notes, which provides a day/time. I make all phone calls from my cell so I can print out a record. The idea is to document your time spent, in ways that cannot be invented--otherwise the other side will try to poke holes in your documentation. With your mom's permission, take photos of her or even a brief video saying hello when you arrive to take care of her. hope this helps.
Helpful Answer (1)
Report

And yes the term plateau was mentioned by PT director. I have requested a meeting with her supervisor. A piece of work.
Helpful Answer (0)
Report

Sorry she is in a rehab with a nursing home.I would not send my dog there after the treatment she received.
Helpful Answer (0)
Report

Thank you both. Mother is in rehab and discharge date is Easter Sunday with no discharge plans made. Today I placed an appeal in her behalf. This facility is now demanding. payment after Sunday. How would I find out about gerontology in NY.?She goes to see her vascular Dr. At Lenox Hill Hospital. Would like info on that .please. I have also called the office of the
Ageing. Boy how they treat our seniors is disgraceful! I also will move forward with getting a lawyer for her head being hit while in hoyer lift 3×… and a facility that neglected care. Boy my work is cut out for me!
Helpful Answer (0)
Report

No there is only 100 days. I used to do hospital claims. You could also look on Medicare website. They are very strict, and getting stricter--no wiggle room. The progress bit is extremely important, they absolutely do not.pay if the pt is no longer making progress.
Helpful Answer (0)
Report

Is she in rehab at a NH that has a rehab wing, and she went there after a hospitalization? IF that's the case, you need to find out what her status is for "progressing". Speak with the PT, OT or social worker at the facility to see what mom's situation is. IF she has reached a plateau, then there's no more progress so no more Medicare benefit.

She would need to either be rehospitalized for a condition for 3 or more days and then get another rehab order done OR if she is living in the community she could maybe be discharged from rehab back other home but her orthopedic doc or maybe her gerontology doc could do orders for another type of rehab that is a different code for Medicare. My mom - when she was living at her home - had a torn rotor cuff surgery; then went home but onto PT for the maximum rehab under Medicare (she was still living at home); then got re-evlauted by her orthopedic surgeon and referred back to gerontology dept for OT evaluation; she got another maybe 90 days under OT. A lot of the therapy between PT & OT cross over but done by different therapists. It must have different codes in order for all this to work by medicare. A good gerontology group (my mom's was within the gerontology dept of a health science center) know how to dovetail all this so that it can work. Local doc really can't imho. If your mom is in a facility, they may not see the need to go through all this as really it may be that mom can't progress anymore and need to be a full time long term care resident.

You need to find out realistically what her medical ability is.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.