My mom is approaching 20 days in a SNF for rehab after falling and breaking her hip. Today someone from the facility called me to say her insurance company asked them to start getting her ready for discharge. She has a Medicare Advantage Plan. I don't understand how that can happen since the orthopedist just told us on Monday that she needs at least 3 more weeks of rehab and that she is still not allowed to bear any weight on the affected leg.
My question is regarding LTC Medicaid. She was approved a few months ago since I was preparing to move her to an ALF. Does the LTC Medicaid program help cover the cost of rehab now that she's past the 20-day mark? I left a message for her Medicaid case manager a couple days ago and haven't heard back. Also, the social worker from the rehab didn't seem very informed about it, either. We're new to the LTC Medicaid program so any insight would be appreciated. Thanks.
You could appeal the insurance pushing her to get discharged by filing an appeal with Livanta/Kepro. I had to do it when my mom's insurance was due to quit paying. (They quit paying when it seems that the patient is not making progress.) I can't remember which, but they did want her Medicare number or her Supplemental insurance number.
For Florida, it's https://www.keproqio.com
https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html
This is something that I kept. Never tried it but you want to talk to someone other than the person who picks up the phone.
Medical Hack
So, your doctor ordered a test or treatment and your insurance co. denied it. That is a typical cost saving method. Here is what you do.
1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/Privacy Officer". (by Fed. law they have to have one)
2. Ask them for the NAMES as well as CREDENTIALS of every person accessing your record to make that decision of denial. By law you have a right to that information.
3. They will almost always reverse the decision very shortly rather than admit the committee is made of low paid HS graduates looking at "criteria words" making the medical decision to deny your care. Even in the rare case it is made by medical personnnel, it is unlikely that it is made by a board certified doctor in that specialty and the DO NOT WANT YOU TO KNOW THIS!
4. Any refusal should be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.
What this means is only Medical people should be making decisions concerning your care and able to access your records. Not people that have no experience.
Have you all noticed the ads for Medicare Advantages lately. Before the word Medicare Advantage was not mentioned in the Ads. It was "what you are not getting from Medicare that you are entitled to" I saw this as false advertising and wondered why Medicare did not put their foot down. Now they are upfront that it's a Medicare Advantage policy and that they do honor Mecicare Part A and B. Which means they must abide by Medicare criteria. According to my daughter they don't and she was always fighting with them. So much so, she called me in the middle of her work day to confirm I didn't have a MA.
"The patient will get worse without treatment".