Mom is in a long term care hospital in Houston, I'm in Dallas. I also have my handicapped sister who lives with me. I would like to have mom moved to a LTCH here in Dallas so my sister and I can be involved in her recovery. I was told Medicare would not cover this because it was a "lateral transfer." If the hospital here has beds available and I have a physician who is willing to take her...what is there not to cover?

IMHO, you should check The rules for Medicare are often difficult to understand and as such, perhaps you would want to get a qualified person to assist you. We used an insurance agent. You may want to as well.
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Reply to Llamalover47

Good question. We need to ALWAYS ask questions ! Doctors will say ok to do something then we find out that they dont know and WE have to pay.
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Reply to Betsysue2002

The poster who asked who told you this has a great point, these rules can be so confusing and constantly changing hospitals and care facilities have a person or two who do that specifically. It could very well be whoever told you this meant well and is either mixing this situation up with another or isn't aware of the way that exists to get an acceptation for exactly your kind of situation. Yes Medicare in particular has some bizarre rules but there are often hoops you can jump through to get around one and this sure seems like one of those no brainers there should be a way to make happen. Your doctors office (your LO's I mean) may know if they are geriatric specialty but likely they wont know how to work with Medicare on this. Also you may have hit the main problem when you pointed out it's Medicare A paying the bill. But 3 years ago or so when my mom was in Acute Rehab I remember there was an option to transfer rehabs but it was not an easy feat to make it happen, we weren't looking to do that I just remember the hospital coordinator helping us place her saying while you can it isn't something you want to try so take some time to look at the options now and consider your choice. Your plan is a good one, your reasons more than valid so don't give up easily here. Also the time passes quickly so get this done asap, it makes a difference giving the patient and family a chance to settle in get a routine and then have time while Medicare is still covering hospital (its covered like a hospital stay and be ware it eats up that hospital stay time every 6mos or whatever it is). So much can be accomplished PT wise once everyone is settled into a routine. Good luck and great job watching out for everyone!
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Reply to Lymie61

First and primary, exactly who told you Medicare wouldn't cover this transfer? Someone from Medicare? Someone at the hospital? Was this person knowledgeable enough to be reliable?

Medicare has at least one peculiar rule regarding Long Term Care hospitals. If an individual for whatever reason needs to be transferred to another LTC hospital, it can't be the one from which he/she was just previously being treated (which isn't your situation, but I'm mentioning it just as an example of the different rules that apply to LTC hospitals).

This happened to my father, in Select Specialty Hospital, renting space from a St. Joe's Hospital. After developing and recovering from VRE, and being transferred from the SSH floor to ICU, someone at SSH (probably a social worker or someone in the billing department) advised me that Dad couldn't return to that SSH. I had to find another one, which I did, 30 miles away. It was a much longer drive, but in a medical community renowned nationwide for its higher level of care.

That doesn't apply to your situation, but I mention it b/c that Medicare rule for LTC hospitals seemed to be to be a bit bizarre. There may be other rules specific to LTC that are equally peculiar. Transfers at the LTC level aren't comparable to those at a regular hospital level.

I believe it was a LTC acute care hospital, but don't recall; this was over a decade and a half ago.

There might be something similar regarding a lateral transfer. I would definitely contact Medicare directly, and confirm in writing if you do get a positive response.

Then ask the doctor who scripted for LTC to script for it at the hospital closer to you.

And confirm with the LTC billing department of both hospitals, just to be on the safe side.

Your plan makes a lot of sense to me; I think it would be easier on everyone.
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Reply to GardenArtist

Medicare...and its a long term acute care hospital, which is billed under part A according to medicare's website. I'll check on the ombudsman thing. Thanks
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Reply to fjordbjorgensen

Go to Google and type in “local ombudsman in Texas”. Did you mean Medicare or Medicaid? Hospital or Skilled Nursing Facility? I’ve read that patients in hospitals have the right to switch hospitals. Call your local ombudsman and ask them to investigate the refusal.
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Reply to Ahmijoy

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