My dad went from the hospital to the nursing home for rehab on August 1st. He was approved for Medicaid starting in September. I took the approval papers to the nursing home business office the middle of September and asked what his balance was up to Sept and they told me $0 (not sure how that was). So I paid her his share with Medicaid (his income minus the $52).
So this afternoon when I was deep in clearing his hoard house, the nursing home business manager called and said Medicare rejected him and I needed to call and appeal and she would let them know I was appealing (which I never said). I asked her what it mattered with the Medicaid. She asked if we were waiting approval and I said no, he's already approved. She then said I better appeal to be safe. How does she not know he's Medicaid approved already!
I assume the Medicare is to have therapy? My dad hates therapy, is end of life, and we just found out his cancer has spread to his bones. Is therapy even a good thing for him at this point? Seems like a lot to put him through at this point.
If he has Medicaid, does he even need Medicare?
On my way home, I kept getting calls from the nursing home. When I got home I listened to the voicemails and it was my dad all upset because they told him his insurance had denied his coverage. The nurses were apparently helping him call me because he was so upset. I'm pretty mad about someone telling him. Is this something they should be telling a dying man with a broken brain?
Medicare is for everyone over 65, and will cover doctor visits, hospitalizations, approved medical procedures, and a limited number of days in a nursing home for rehab after hospitalization. If your father refused rehab (or is not suited for rehab), then they can not bill.
This is where Medicaid picks up the expenses that Medicare will not pay. Such as long term care in a nursing home. Or durable medical equipment.
I don't know if you would be successful trying to appeal the Medicare decision, but, talk to the social worker who approved the Medicaid. You may be able to get reimbursed for some past expenses 30 days prior to the Sept 1st Medicaid approval date. I have some really vague memories of receiving paperwork to that effect when my husband was approved for Medicaid back in 2015.
I'm sure the nursing home will continue to hound you for payment. If you want to appease them, it may be worth paying the bill (or at least something) but do not sign anything as a responsible party for payment! This is your dad's bill, and he may die owing them. They can write it off or try and get it from his estate.
it sounds like the facility is trying to get your father approved for physical therapy or other Medicare services, and Medicare has denied them. Because, as you said, at this point PT will not help him and will likely cause him discomfort.
The key thing to verify is your father technically still receiving rehab services daily? Or has he been deemed non progressing after the 100% Medicare coverage of 21 days? Either of the two is the reason for denial. But, the nursing home should be aware and then transfer his status to Mediciad LTC (from SNF Rehab status) unless there is no Mediciad LTC beds available.
As absolutely insane in notifying you father it is a regulation that the patient needs to be notified. This happened to my uncle and he also was very upset. I would just reassure your father that you are taking care of the issue and have it under control. Wishing you the best of luck.
A rehab facility is not the same as a nursing home, so the staff may not have been informed that you are his DPoA (per your profile info). I would definitely have this discussion with them and make sure you've submitted the DPoA paperwork to them. I would be checking on him daily to make sure he's eating and drinking enough and that his hygiene is being tended to. Remember: rehab is not the same as AL or MC or LTC.
I wish you success in helping him get the proper care and peace in your heart as you make decisions for him.
Medicaid is separate. It covers nursing home costs for people whose assets are under certain dollar amounts.
It seems that Medicare has refused to pay for a specific treatment or therapy. It's important to find out what the denial of coverage is for.
It might be possible for your father to receive hospice care at this point. If a physician approves, Medicare will pay for hospice care.