My mom left rehab -- will Medicare still pay for her stay? - AgingCare.com

My mom left rehab -- will Medicare still pay for her stay?

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We realized very quickly that the rehab had horrifying conditions at night. We still let her stay because we were threatened by numerous staff that leaving would open her to not having the stay covered by Medicare. Also, the therapies during the day were excellent. If we could have, we would have driven her for the therapies during the day and brought her home for the night. She lasted two nights, with no sleep either night. We stayed with her both nights. The conditions were terrible at night: people screaming at nurses, adult children yelling at a nurse, nurses sleeping in the hallway, six televisions blaring until the morning, constant stream of people in the room. No sleep either night. She doesn't remember any of it. I took her home and then to her primary care physician and a couple of other specialists for follow up. What are your experiences? Is there something else I should do to make sure she gets reimbursed for this hellish stay and also make sure her complaint is registered and heard and perhaps some changes are made by the facility for the next person to arrive there?

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Genevieve glad everything was satisfactorily settled.
This experience underscores the need for every patient to have an advocate who is prepared to speak up and demand answers. it does not hurt either to do research on whatever proceedure your loved one is going to have. Long waits for call buttons to be answered is totally unacceptable. I was told by the supervisor at the rehab i was in that if all else fails pull the wire out of the wall as that sets off an alarm. I had already tried calling the front dest so be sure to have that number and in the hospital the nurses station.
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Gen, I'm so glad that this worked out. I might think about sharing all this in writing with the discharge planning section of the hospital that sent her there.
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I would like to follow up on this, that my mom's stay was covered in full by an insurance policy that is held by the rehabilitation facility in which she stayed. The justification for the coverage was that the paperwork filed by the rehab was inadequate to justify my mom's stay at the rehab facility, but that the rehab had not notified my mom of this in a timely manner, therefore they had to pay the whole fee. Additionally her hospital stay prior to the rehab nightmare experience was covered, as it should have been, at the proper Medicare rate. Who knows if her case is flagged? She hasn't been back to the hospital since, knock on wood, and you can bet I will raise furies if she is not treated properly should something crop up and she needs emergency assistance. I hope this may help another person who may be reading this and thinking that they have to allow their loved one to live with sub-standard conditions in a rehabilitation facility even if this is only realized after entrance to the facility. No, it is not necessary, and complaining on behalf of my mom worked in my case. The complaints were detailed, named names, and gave precise dates and times of events occurring. I did pass the complaint by a friend who happens to practice law, and the friend helped me with some of the verbiage of the complaint to make it stronger.
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Hi, igloo572, The tone of your letter is pretty much what we got while we were taking care of mom at the rehab. Nope. I sent a letter to the facility documenting in detail and with names all the concerns including ones I don't want to list here on the world wide web, as well as copied licensing and the elder patrol for medicare so it's all documented that this was an unacceptable place to stay, no matter what decision is made on payment or nonpayment. That wasn't the point. An administrator did call back to state verbally that each point, point by point, will be addressed and they will provide their response in writing within two weeks. Additionally, we will appeal if it is not covered. "Noisy at night" was unfortunately not the only issue; sleeping nurses at night and slow response times to call bells and unsanitary conditions where they should be clean/sanitary.

Thank you jjariz for your advice. I shudder to think what would have happened (broken leg, terrible deterioration in her condition) if we had not taken her out of the rehab when we did. Should have done it the first night.
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Genevieve, Don't let the above info freak you out too much. If you get a denial letter, be sure to register a TIMELY appeal based on the appeal procedures in the letter. I took my DH out of rehab after one day because they had no bed alarms, and he was a serious fall risk. They claimed that bed alarms are unreasonable restraints. I claimed that the facility was unsafe for him. I won.
Blessings,
Jamie
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If they leave AMA (against medical advice) & without discharge paperwork, insurers can review and determine that the service will NOT be paid; services are often paid via "bundling" so has to be completed with status reports written up by licensed health professinal for payment to happen. Also any near future medical with the same ICD codes may not be a covered service. What then???
This could be seriously a huge amount of $$$ that debt collection can go after BUT more importantly limit her ability for future care. With electronic medical records it's all there & eventually will surface.

She's going to code up as non-compliant for care. Her GPs assessment will be totally overridden by the hospitalists, PT, OT other rehab professionals documentation in her health chart. I'd bet a case of prosecco that there's an AMA earmark on her health history for the day when she is re-hospitalized. AMA can be a redflag for APS to look into. She or you, if DPOA, had better to a very detailed specific timeline of her stay at the facility & why you know & can evaluate her careneeds better than hospital / rehab staff to have on hand if APS enters moms life. "Noisy at night" isn't going to cut it, if APS gets involved.
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Hi, freqflyer, the new place is her home. She has already seen her primary care physician who gave her a clean bill of health, and she is back to her regular routine. She is a little tired but no worse for the wear. In fact, she doesn't remember a thing. Too bad I am so much like an elephant and you know what they say about the memory of an elephant.
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It is my understanding that if a patients leaves a facility against doctor's advice, then it can become complicated as to whether Medicare would pay for the days used, or would refused any future care for that certain medical issue.

Usually when one is in a hospital, the discharge nurse tries to find "an open bed" thus Mom would be sent to that rehab center. Insurance companies want patients out of the hospital ASAP, no sitting back waiting for another rehab to have an open bed.

You can look for a new place on your own but would need an doctor's orders to get in. To transport your Mom to the new rehab, the cost would not be paid by Medicare [they only pay to the first rehab]. Hopefully she can ride in a car.

Hope you find a new place that is a lot quieter.
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Oh boy... sorry Genevieve. I cannot imagine how having a loved one at rehab would be a vacation. Whoever said that to you is clearly out of touch.
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Thank you staaarrr, this information gives me some forward direction. I will follow your advice. It seems like somehow it is in the culture of the place. One of the persons there even said for me to look on the rehab as a vacation for myself. A travesty! Nice vacation knowing a person you love is trapped with no sleep and no way out!
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