I asked the care worker for a copy of the form to appeal to Medicare regarding the discharge. The care worker said he didn't have Medicare. I hope we can clear this up tomorrow, but A he does have Medicare, how could they not know that? B He needs physical therapy and speech therapy, but they want to send him home, C How do I get him the proper care?
Your SO was/is out of network, an issue of an AP.
Contact your SO insurance using his card and find out how to get w/n the system that is available to SO.
Hopefully SO was able to get the care he needed for the stroke in a timely manner.
You might want to read the info on problems with Advantage Plans. If you know more about the issues, it might help you get SO the care he needs.
Note. This website is NOT part of Medicare but it is a very informative recap of many of the issues.
This problem of being taken to a hospital that is not Kaiser for an emergency must happen often enough for there to be a proper course of action.. Call Kaiser.
‘Good luck and please let us know how you managed this. We learn from one another.
https://www.medicare.org/articles/five-hidden-disadvantages-of-medicare-advantage-plans/
I am honestly quite shocked at what you are finding here. Your appeal now is to Kaiser if you wish time in rehab, which Medicare does pay through the Kaiser plan. Ask to speak with social workers at Kaiser about followup. I suspect his being at Sutter has thrown some sort of monkey wrench into things. If Kaiser diverted him there (my own hubby was diverted to Zuckerberg/General when he sustained a stroke, by Kaiser. He got marvelous treatment there, cost picked up by Kaiser plan which diverted him to their stroke center. He didn't require rehab as your husband does.
Speak to the social workers today. You will need to appeal this as an "unsafe discharge" without rehab. Have someone with you. It is difficult to hear in times of this type of stress.
Medicare cannot help you. You need to call your Medicare Advantage and ask them why your husband is being released to Rehab. If you feel they are not doing what parts A & B allow, then you call Medicare. Mayne Kaiser can help you.
"Advantage" plans often supercede regular Medicare and often are no advantage at all once a person needs actual medical care. Then it operates more like an HMO where pre-approvals need to happen first. Advantage plans mostly benefit people when they are NOT sick or in need of medical care. If you want free bandaids, vitamins and acetaminophen and gym membership discounts, this is mostly what Advantage plans give you.
You need to first confirm what he has. Then he needs to assign you as his Medical Representative so that his doctors can actually disclose his private medical information to you. If you are not his PoA then he will need to be on the phone with you when calling Medicare and/or the Advantage plan service rep.
Did he have a TIA with minimal aftereffects? Did it cause problems that require PT and rehab? Just trying to get some context for this situation. If the docs don't think he requires rehab then they won't order it. PT has to be ordered/"prescribed" by a doctor.