The insurance co. wants to kick my Mom out of the rehab. What do I do?

My Mom can't walk and now they found bacteria in her urine.

Answers 1 to 10 of 33
Is the rehab being done under her Medicare benefits in a SNF as part of a post-hospitalization event? Was she able to walk prior to the event? Did the UTI occur during her stay at the current facility? How long has she been there? Was there a 'Care Plan' discussion during rehab? Need a little more info.
Yes rehab was done after 15 days in the hospital with sepsis she walked into the hospital now she can't walk her ins co is Aetna from her job . Yes the uti just happened. No care plan was discussed .
Thank you

Who is telling you that the insurance company wants to kick her out? The administration at the NH? What did the NH actually tell you?

If mom was 15 days in the hospital (admitted, not under observation) then typically she'd be eligible for 20 days of rehab covered by Medicare in full, with another 80 days covered at 80% I believe. But she has to show progress in therapy. If you didn't have a care meeting, how were you informed?
Robin, if she cannot or will not participate in PT, she either goes home or goes to long term care. Talk to the discharge coordinator AND the social worker.
Robin - I'm so sorry about the sepsis dx. I hope, by now, you have an update on her condition and prognosis. You indicated that this might be more of an insurance (Aetna) issue? She must have had a doc's order to go to rehab and rehab doesn't 'kick you out' unless you can't/won't participate in their care plan. Most of us are used to dealing with Medicare, which doesn't require Prior Authorization for such things. Maybe Aetna was lagging on the Prior Auth? Pls keep us posted on the situation.
Hi I did an appeal but Aetna turned us down I am not sure what to do next. I just don't understand how they can refuse her coverage when she can not get up and go to the bathroom on her own. She was a independent 78 year old women who was able to take care of herself. I am not sure where to turn for assistance
Top Answer
What does the denial letter specifically say? Does she not have Medicare as a secondary insurance? The admissions coordinator, financial counselor, social worker, or even discharge planner might have some input and help into this. Documentation needs to be clear that this wa an acute deterioration of her level of function.

Aetna - like other for-profit insurers - does not stay in business by paying for medical care; they stay in business by collecting premiums and weaseling out of providing medical care. That said, unless they specifically exclude the service, they may be required to cover it. Your physicians and maybe the state insurance commission could be allies in this battle.
Rockinrobin, how are things going?
Medicare will cover 100% of the cost for day 1-20, after that she would have a copay. It depends on what her insurance will cover. I'd have her reevaluated and ask for a care plan to come up with a solution for her to improve before going home. You can also contact your local long term care ombudsman who is an advocate for residents in facilities.
Thank you all for your advise . Right now I am waiting for the rehab to get me all the information in ref to her care plan then I am going to apeal her case one more time. Any advise on what say would be greatly appreciated.

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