My mother’s SNF called Friday saying that insurance is only covering her care through Sunday despite our paying to keep her longer. Can I appeal?


She’s still unable to walk more than 20 feet assisted with both a walker and the PT. We have paid to continue her care through the 31st. What can I do to appeal this? They still have not had us sign a NOMNC.



From your profile: "Wife and mother of 2 young children caring for my 68 yr old mother who has HOCM, Mitral Valve regurgitation, DVT’s, Pulmonary Emboli, bladder and bowel Incontinence, Parkinson’s and Dementia. She’s currently in a SNF and moving in with my family at the end of July."

Are you going to be fulltime caregiver for your mother once she moves in? Are you prepared for this? Do you WANT to do this?
Helpful Answer (0)
Reply to CTTN55

Is your Mom in Rehab 'post a 3 or more day hospital stay'? Does she have secondary medical coverage? Have you asked them if they would pay?
Personally, I would opt for as much help as possible. In rehab, they need to show improvement for medicare to continue to pay. That type of progress takes longer for some patients than for others.
Assuming Mom was able to walk more than 20 feet prior to being in the hospital, look for more improvement. You don't mention how old she is or her living conditions or issues, but you might review her progress with the SNF. After my Mom was in rehab, I learned that the therapists had no idea she hadn't used a walker prior to the hospital stay. They were frustrated with her inability to use it at rehab --- despite my having answered such questions at admission correctly.
Does the person telling you she has to be out by Sunday know you are willing to continue services? Often, the right hand doesn't know what the left hand is calling about! It sounds like a meeting is in order. And as an aside, PT/OT etc can continue once she gets home.
Helpful Answer (1)
Reply to geewiz

Are u paying everything room and therapy? If so, insurance doesn't matter if your footing the bill for next 11 days. Don't understand the problem. Be aware. Mom might have hit her plateau and no amt of therapy is going to help.
Helpful Answer (1)
Reply to JoAnn29