Is it possible to negotiate home care with Humana? -

Is it possible to negotiate home care with Humana?


My soon to be 87 year old mother is almost blind, broke her arm in March and fell on July 12 and fractured her pelvis. She is in the skilled nursing unit of our hospital. We live together and I am her primary care giver. I work from home, which is good, because she has frequent falls. I found out Saturday they are releasing her to come home tomorrow. I don't think she is ready. She can't walk, even with her walker, alone. She can't go to the bathroom without help. They told me I need to talk to the discharge planner and therapists to find out what we need at home, what her Humana/Medicare replacement plan will pay, etc... The first day she was an inpatient, the home care coordinator told me they would get home care set up and ensure it would be paid for.

Can I try to negotiate with the insurance company to get what we need at home? We have a private agency that provides 3 short shifts a week now, we did that after her fall. I plan on keeping them, but I have a huge concern that mom isn't ready to come home. She really needs full time care. I am getting ready to go the hospital now and start getting some answers. They just sprung this on me that she is coming home tomorrow.

I don't feel prepared at all for this and she should have coverage there for 90 days, I am sure insurance is just saying it's time for her to be released.

I look forward to reading more posts, I have been her caregiver for 8 years, since my father passed away. Before that, I stopped to check on them daily and was my father's POA.


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Keep up the great work. It is sad that we have to do so much of the advocating ourselves. But if you do not look out for yourself NO ONE ELSE WILL!!!!!!
The sandwich generation!!! I'm glad to know that at least you have some background and skills that will serve you well. They should have never sent her straight home, in my humble opinion, but what do I know!!! I'm just a medical professional!!!!Blessings
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I should have said we are getting PT and OT at home, as well as a skilled nursing visit weekly. I guess our senior center has funds for respite and they aren't as restrictive as far as your assets. My dad had a great case manager there and she has taken over for mom, she is going to see how much respite care I can get. She said they do dishes, laundry, light cleaning, keep mom company, they just can't lift her. That will be a huge help. I can either work in my home office and not have to worry about mom or actually get out of the house. I am going to call Humana and ask for a nurse manager that I can keep in touch with. I had one of those when my son was a baby, had a trach and 18 hours per day home care.

I am so glad I found this group, I know my siblings get tired of me complaining, though they don't seem to help.
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I can't believe a social worker didn't speak with you and have her evaluated for therapy at a rehab center! I know a nurse from Humana phones my parents on a regular basis to check in. I would definitely contact Humana and see if they can help, or check with your doc for an order for home health visits and physical or occupational therapy. They do both therapies outpatient (altho I've never been too impressed with the visiting phys. therapists).
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I did negotiate after what the hospital told me they would pay. I didn't know what to do when they said she had to go, because if we appeal and lose, she has to pay for her time there. If she would do what they say, she will be fine. She came home, but either she isn't hearing her instructions, not comprehending them or just stubborn. I ended up more home health aide hours than they first said and we will supplement with our private pay. The hospital nurses were shocked at how much I got, but I wouldn't back down.

I work as a medical auditor for the government, so I know a few tricks and can negotiate. I am just surprised they didn't recommend rehab. She had been in a skilled nursing unit for most of her stay and was getting therapy daily.

I just hope she improves quickly, she doesn't do well with the walker.

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I recommend that you call customer service at Humana. If you do not get a satisfactory answer, ask to talk to a manager or supervisor. Do not let them put you off!!!!!!!! Keep calling till you get the answers that you need and deserve.
Also, just because the hospital says she needs to leave, is not always a good enough reason. They do that because they will not get any further payment from Medicare, if she stays there longer, due to what are referred to as DRG's.
If she is unable to ambulate, you may want to check into a long term care facility
for rehabilitation. That sounds, like a more reasonable decision at this time. That does not mean your mom will never be able to come home. But I would think that if you need to work, even though it is from home, you will need some sleep!!!!!!!!
I hope this helps you a little. Blessings
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