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

Medicare may not pay for it. A better approach may have been to request transfer somewhere else. She must need rehab. See if you can get her into another facility with a doctor's order. You can report the facility to the state licensing agency and corporate office. Remember these facilities have many people in them that are not the least bit happy. They have dementia and other illnesses. Behaviors at times, especially with the elderly, are impossible to treat.

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!

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.

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.

Thank you. Wish I had thought of that. However, there were no staff forthcoming with any solutions. It seemed like no good solutions, very frustrating that discharge planners or social workers or someone at the facility could not have offered the solution of transferring to another facility.

Medicare should pay for it. Payment is determined by whether or not the services were medically necessary. It sound like they were. Doctors, hospitals and facilities like to perpetuate a myth of non-payment in order to get someone to stay. If you are worried at all, call Medicare. They will tell you if there would be any denial due to someone leaving a facility AMA.

As for the complaints about the facility, write a review online, call the administrator of the facility and let them know what you witnessed, and call the ombudsman and the state.

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.

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.

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