Medicare statement saying $0 is covered for hospital bill because of Hospice

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My FIL was swtiched over to hospice way, way too early. He was cathing himself and then needed a cather put in but his visiting nurses could not do it. He refused to go to the hospital and then one day put a gun to his stomach threatening to kill himself. When visiting nurse found out, they said he needed Hospice to be called in. We asked if Hospice is a facilitate to die organization and was told no.
Hospice comes in and does little. No real help to the family, late to visits, etc. The main thing FIL wanted was pain pills. And more pills. And more pills. And they were happy to supply. Then his kidneys got worse and no urine was coming out when he cathed himself and he kept swelling.
Both visiting nurse and hospice nurses could not get a foley cath in. The social worker came in one day, called my husband and asked how much FIL had in the bank that he was going to a nursing home. They leave and FIL calls my husband and says, "I want to go to the hospital."
The nurse at the hospital got the foley cath in, a tremendous amount of urine came out. That has been close to 3 months ago and FIL is in rehab at a nursing home. Our family had hospice removed because we were told he could not have certain tests done.
We have now received a statement that Medicare has paid $0 on his hospital bill (over 18K) because he was a Hospice patient. Is this billed under a supplemental policy or does Hospice receive a bill and then turn it into his insurance? Anyone else experienced this?

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I work for hospice. If the hospitalization was RELATED to his hospice diagnosis, then Medicare will not pay, the hospice will be responsible for paying it. If it was not related, then Medicare will pay. What should happen is that Medicare should have sent the bill to hospice to be paid, and then hospice should either pay it or resubmit to Medicare if it was for an issue unrelated to the hospice diagnosis. You need to take the bill to the hospice office and have their revenue coordinator or billing person resubmit to Medicare.
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I have to say that I contacted Hospice at the daycare mom used to go to, and over the phone for 3 years of my Moms alz disease. I asked so many questions and I would not have Mom admitted to them until they could promise me morning care "and" that my Mom could keep her doctor. I was assured they just hired new CNA's and it was no problem.
Where did that get me? I only got 2 mornings of which they couldnt handle alone and had no one else, said Mom was a 2 person assist, yet I was there to assist so...? Also iif Mom went to the Doctor, YES she could go, but she had to pay. This was the best Hospice around I was told after I had tried one previously but ended up not signing on with them as they had no morning help available and couldnt even say when they could or would come. So, in the VERY end I suppose they might be good but they now take on patients years in advance. My Mom was given (only by Hospice) 6 months to 3 years and 1 year ago. When I questioned that they said they really cannot tell how long someone will live with asz disease but "oh no worries, we just re-evalulate and sign them on again every 6 months."
Joy, You're going to have to fight this, maybe get a lawyer. I think because the Hospice Lady couldnt get a foley in--you had no other choice. And that Social worker, shame on her asking about your FIL's money! All she had to do is have you sign a discharge paper from Hospice and it would have all been paid. I feel so bad for you!
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As with all facets of medicine today, especially in cases with Elder patience where they are unable to communicate their own needs (but also in the case of children and even yourself -- why do you think the experts recommend a second opinion as well as taking an advocate with you), we all must inform ourselves about medical conditions and ask the right questions to keep the doctors and other powers that be from killing us.

Just today, I was told that the mother of a person I know who was taken to the hospital a couple of weeks ago is now going to have to undergo a second procedure to place a stent in her heart vessels, along with a second anesthesia that will be required, and all because during her first trip to the hospital, when she arrived at 6 a.m. one day, neither the attending Dr nor any of the supportive staff thought it important to call in a cardiologist until 3 a.m. the following morning. By the time the doctor arrived, she had been without care for 23 hours with a known heart insufficiency. The cardio was fuming, took it out on everyone in the ER and not any of them in the ER objected to the cardio's screaming about and throwing things (hmmm - demurily thought it was justified I gather). He needed to do angioplasty and place more than one stent. The mom's body however was weekend from the experience and she nearly went south on the operating table. They patched her up and send her home knowing she would have to come back in a couple of weeks, when she was stronger, for additional surgery. Already really bad, right? Now get this. Even after his justifiable tirade, the cardio is on willing to stand up for the patient and talk with a lawyer!

So, this post was meant to be about hospice although it might grated into other areas. There is nothing wrong with hospice or the concept of hospice. The problem is the people that are working at a particular Hospice. What we all need to do is what is legally referred to as "due diligence". Read here, read other places,familiarize yourself with the experiences other people have had. Develop I set of questions that are pertinent to your patient. Go out amongst the hospice people before you need them and ask your questions. Just like any sales person, ask if the answers they have satisfied you with are in writing in the contract you're both be signing. You won't be having any problems with the good ones, only the bad ones will balk at your examination of their processes.

In many cases, the case managers who do discharges at the hospitals are used to interfacing with the Hospices who are called into the hospital to evaluate for the appropriateness of hospice. These case managers probably cannot give you the one they think is the best but they probably can give you a list of 3 and those are the first that you should start checking on.

Please don't forsake the hospice concept all together. They can be very helpful in your loved ones and stage and you are not necessarily going to get that kind of cooperation from the primary doctor. Hospices are allowed to administer much more anxiety and pain medication fan and non hospice doctor is willing to do because he is differently under the scrutiny of the AMA and the DEA.
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PS I just remembered something else. I did ask Hospice right along, even before they came, if my Mom could keep her own doctor and they said of course, of course, etc. When I questioned them again after they told me about the no-hospital rule , they tweaked it to, "yes but you will have to pay for it, dont worry we can take care of everything." To me that pretty sneaky. Ohhhh yes you "can" go to the Dr, and you "can" go to the Hospital "but" you will pay!
I will not use Hospice unless my Mom is dying and in pain and if the Dr wont order her pain meds if she should need them.
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Joy, its true, I have written about this on this site before. I had a 4.5 hour intake for my Mom to go on Hospice. They promised me morning care daily and thats what I desperately needed. AFTER Mom was all signed up at my kitchen counter with me, the Nurse said, "now don't call 911 or take her to a Hospital, we will take care of everything for you." I was like "what!" I wanted details! She said that Hospice is now in charge and I have now chosen it over the expense and stressfulness of going to a Hospital and that my Mom will die at home. She continued to say that they can take care of everything, just call them. By day 3 I had no one because my Moms a difficult case, late stage alz. The first girl couldnt hoyer her into the wheelchair and the second girl couldnt roll her. I had phone calls, a nurse, chaplin, pt, ot people coming and calling and it was more of a p.i.t.a. than anything! I insisted they come and discharge me out immediately. they only offered "possible afternoon help" but they darn well knew my Mom napped afternoons and I only need help getting her up and bathed. I feel so bad for you. If Hospice did not tell you you couldnt go to a Hospital you will have to fight it. If your intake was like my moms, I , as her dpoa signed right on the nurses computer and couldnt read it first! She also never gave me copies she promised. During disharge I made her put in writing the date and that my Mother was now NOT under Hospice. I want my Mom to pass at home but if she should start to bleed profusely from her nose or a wound, etc, I want that assurance I can call my towns 911 for help. Obviously this wasn't made clear to you or you wouldnt have gone to the Hospital. Worse case scenerio, pay them $5 a month and after your Dad passes, isnt that bill null and void anyway?
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This is a scary post! My husband will soon require hospice. I can't imagine facing that scenario PLUS the costs that you are stating. Where is the justice in any of this? It's always about the money, isn't it? Greed is so evil.
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I had to take my Dad to the hospital. In order to make sure Medicare would cover it the hospice nurse informed me that I would have to sign a paper taking Dad off hospice. She told me this because she didn't want us to have a huge bill to pay. So I signed him out of hospice. This is the first thing they told us when I called and said we were going to take him to the hospital. I don't know why your hospice didn't do the same. Maybe you have a case against the hospice. The hospice said when he is better(we were thinking he had a stroke) call and he can be put back on hospice. The hospital said he would have to go to a nursing home and stay. They don't know what happened, but his mental condition is so bad overnight he will not be able to return home. They said after he received physical therapy to call them back in. He has kidney and cardiac problems.
It sounds as if the hospice is at fault for not telling you this.
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jmcgrath - "If he was on hospice at the time he went in the hospital, Hospice is responsible for the bill" is true only if the hospitalization was related to the terminal diagnosis. And the hospice organization should work with you to make sure the bill is accepted by Medicare for payment if not (related to terminal diagnosis). I work for a not-for-profit hospice in the Midwest and am appalled at what I am reading! In my 11 years with hospice I have never seen any of the abuse and lack of compassion expressed in some of these comments. It takes the signatures of TWO physicians - not nurse practitioners nor physician assistants - to qualify for the first 90-day Hospice Medicare Benefit along with documentation and supporting medical reports. It then requires more documentation and physician signatures for the second 90-day benefit. After that, a face-to-face meeting between the patient and either a physician or nurse practitioner is required to continue your HMB in 60-day increments, each proving that the patient remains hospice appropriate.
My heart goes out to those families that not only had the heartbreak of losing a loved one while on hospice services, but then they also had horrible services with their hospice organization.
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Like every other service there are good and bad hospices and good and useless nurses within each.
The Medicare regulations that have to be followed are very strict. the Hospice receives a daily rate of payment for each patient and it is often difficult to pay for everything the patient needs within that amount. Some young patients use their primary insurance as long as it has a hospice benefit, otherwise they pay out of pocket on a sliding scale. many hospices hold fundraisers to help defray their costs. Hospices nurses typically are paid less than their hospital counterparts and receive lower benefits. making ends meet is a constant juggling game which explains why certain supplies are sometimes in short supply
The be eligible for hospice the patient must be certified to have a condition that can be expected to lead to death in six months or less. The MD must certifiy this and often will do so as long as they have seen the patient within the last six months. Often a patient's PCP will be a FNP or PA and the MD will never have actually seen the patient. an MD other than the PCP cansign the paperwork as long as they have been seeing the patient and often this will be someone like an Oncologist or renal specialist. Every cost associated with the terminal illness will be covered by hospice at their discretion so if you decide you want to go to the ER for some reason and it is not cleared with hospice first they won't pay.
Putting a catheter in a male patient can be very difficult if not impossible because elderly men tend to have enlarged prostates so there is no shame in not being successful at inserting a catheter but it is easy enough to check the patient for an overfull bladder and take him to the hospital where an MD can evaluate and treat. Hospice will usually pay those costs but if he refuses to come home when ready for discharge, hospice has the option to discharge him from their service. Hospice will continue to care for patients in hospital usually for five days when they will have either died or are waiting for nursing home placement. Hospice is able to continue to care for patients in N/H but only if the N/H allows it and many don't. If the patient leaves hospice normal nursing home Medicare/ Medicaid regulations apply.
Patients can be discharged from hospice if their condition improves and later be re-admitted for the same or another condition. The hospice may pay for things like radiation or chemo as long as it is of a palliative nature for example to shrink a brain tumor and relieve symptoms.
As most people know Medicare/Medicaid and any kind of health insurance can be an absolute minefield so question, everything, do your own research and demand answers which is not easy when you are dealing with end of life issues so the best advice is to be proactive when there is a family member with a chronic illness. Good wishes to all those doing and who have made the selfless sacrifice to care for a loved one.
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If he was on hospice at the time he went in the hospital, Hospice is responsible for the bill. They take over management of the medicare/medicaid or other insurance when they come in. Sorry you had a bad experience. Hospice is generally a very good service and should be in 6 months or more prior to death. They are very caring and helpful. Most people have misconceptions of what hospice is. They don't come in and take over the care, they don't stop other medications, or stop feeding them etc. Pain management is definitely a focus. A nurse will be in usually once a week to check on the family. An aid may be able to come in for a few hours a day to do personal care. They cover equipment and medications related to the terminal disease for free. They also have volunteers, spiritual help and education for the caregivers. You can opt out of hospice at any time and resume your health ins. and treatments if you wish.
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