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

Jenny, people don't go to nursing homes to die. My mom, post stroke, post hip surgery, is in a NH. Got therapy to get her walking again. It stopped being paid for by Medicare when she stopped progressing. But each time she went to the hospital for three days ( a fall, pneumonia), it would be covered by Medicare again until she stopped making progress. Mom has gotten much stronger physically since going there.

An elder really has to be willing to accommodate a bit to the therapy schedule, it's sort of like going to school. Are there other reasons why she's so tired? Is this an acute rehab facility ? Maybe she needs a subacute facility .

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!

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.

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.

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?

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.

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

My 86 y.o. mom broke her hip on Mother's Day and is in a nursing home/rehabilitation facility. She is considered "short term" during PT and Medicare pays 20 days, after the 21st day Medicare pays 80% and her Blue Cross picks up the other 20% til the 100th day. While in short term, Medicare requires progress updates, and only if she is not progressively doing better with her therapy will Medicare reevaluate her for possibly discharge from short term and stop paying. I already filled out "long term" Medicaid paperwork so that in the event she is discharged from short term to long term care, Medicaid will be in place, (hopefully). Also, after the 100 days, my mom will probably transition into long term anyway, therefore, Medicaid will have to be in place to start payment.
I also had certain rehab facilities refuse to take my mother, but it was based on a facility that had a more rigorous physical therapy requirement, like 3-5 hours a day. Since my mom is 86 and has dementia, there's no way she could have withstood that amount of PT. BUT, these rehab places would not have kept her but 2-3 weeks at most, not 100 days. A nursing home with rehabilitation is what you need. Just make sure you go and check the places out prior to transferring her there, and it's a good idea to make sure the "short term" patients are separate from the "long term" patients.

my mom has alzheimers and had a stroke recently. She was kept as inpatient in hospital for 8 days and transferred to subacute rehab. Hers was a "small" stroke. Haven't been told how long she'll be able to stay. I have no longterm plans in place. Overwhelmed

Talk to the dovial worker at the favility about when a "care plan " meeting is schedled. You will meet with her therapists and a plan will be developed with you . Think about whether she will be able to manage at home, post rehab.