Insurance company trying to have Dad sent home from rehab, he just got there, what can we do?

It may be a Medicare issue. They have all sorts of regs about rehab, hospital stays etc. When my mom had a TIA, she was admitted "under observation", not "in-patient". She was there 2 days and discharged, although we argued she was an unsafe discharge. She fell two days later, hit her head. This time, she was there for 3 midnights, which met Medicare requirements, was transferred to a rehab where Medicare picked up costs per their schedule. The rules are tricky and even with insurance, often Medicare is primary. I'd call the rehab center and find out what they know, then call his supplemental insurance company. This stuff will make you nuts - I'm currently fighting an ambulance bill because the EMT misheard my mother, who was perky as h*ll, and noted that she fell out of bed and was chatting away. In the ER however, she was loopy, vomiting and had a concussion. She was "performing" for the EMT and it's going to cost me $500...argh.

Immediately contact the facility and get the facts. Mom may be a little confused. Medicare should cover 20 days of rehab after a hospital stay. IF the patient has been deemed unable to be rehabilitated, then he should be transferred to long term care and you will have to find out if your parents can pay for that or if they need Medicaid or VA assistance. Dig deeper

Thank you. My siblings and I are going to have a phone conference with the rehab on Monday afternoon. Dad was in the hospital for more than a week so the three midnights requirements should have been met, right?
I'm sorry to hear about the ambulance bill you were given! That's awful. Can I ask why you have to pay when it was for your Mother? I can barely meet my own bills, I hope I don't start being asked to pay my parents expenses.

Thank you pamstegman. I will do that.

You won't be expected to pay your folks' medical bills - I'm going to work with them to reduce the amount, as she only gets $67 a month, being on Medicaid. I just need to eliminate the stress of this bill because I have more urgent things (MIL in hospice care, trying to aid FIL in caring for her) to focus on. If your dad served in the military in wartime, he can apply for the Aid and Assistance pension to help with cost of his care. It does take them some time to process (ours took 7 months) but is retroactive from when you apply. Mom received a lump sum in her bank account, then monthly deposits. It really helped. Once she went on Medicaid, the A&A stopped since Medicaid took over. I hired an elderly care attorney, one hour meeting, to discuss Mom's assets and Medicaid spenddown. It was money well spent because she knew all the finer points of Medicaid in our state. Our application for Mom went thru easily because we were prepared. We knew that Mom would need to be long term and let the rehab center know that up front. Then when a long term bed became available while she was in the 100 days of rehab, she was moved to that bed. She still got her rehab therapy - she just was in the long term wing, not the rehab wing. You're blessed to have sibs working together on this.....it'll all be ok.

Thank you Linda22 ! That is great information. I like the idea of a short meeting with an elder care attorney. It sounds like it is well worth the money. Gosh this website and you folks are an absolutel Godsend!

Since your father was in the hospital for a week, he should clearly be qualified to go to a facility, but I'm wondering if you're referring to a skilled nursing facility with rehab or a different type of facility?

If you can afford to take time off from work or other pressing issues (and it sounds as if there's a lot going on in your life right now), it's a more effective "power move" to deal with the nursing admins directly. Go prepared with a list of questions and be firm about getting answers. It wouldn't hurt to call Medicare tomorrow or Monday before you deal with the rehab facility.

And be sure to talk with someone who has the capacity to make decisions. Don't let them shove you off on someone who just presents information but has no authority.

And use "power seating" tactics. Position yourseld and your sister (and brother if he can come) in such a way that each of you can watch a segment of the people with whom you're meeting. It keeps them focusing on just the two of you together and you and your sister can also observe them from the different angles at which you're seated.

We had to confront the staff of the first nursing home my mother was in for rehab, primarily because the therapist assigned to her was judgmental and insisted that my mother wasn't cooperating in her rehab. We also had a doctor's order that she be non-weight bearing for a given period of time. The therapist was insisting that she bear weight on her broken leg.

It was a bit of a tense meeting - we were outnumbered by about 3 to 1, but my sister was a psychiatric RN supervisor and I was a paralegal (and former contract administrator) so we held our own against them.

The end result was that the therapist was transferred to another facility and a very gentle and understanding female therapist was substituted.

I also second the recommendation to contact an elder law attorney if you don't get a satisfactory resolution with the nursing home staff.

Good luck.

Garden Artist has given great advice. You can record the meeting too via your cell phone.

You need to take a copy of all your current legal - your DPOA, MPOA and any advance directives to the meeting along with his health insurance details.

Is his insurance Medicare? If it is Medicare and since this is post hospitalization Medicare will usually pay 100% for the first 20 days for rehab. Now until recently after the first 21 - 28 days they could continue on rehab under Medicare but with a co-pay of about $ 150 a day IF they were "progressing". There has been a recent ruling (Jimmo V. Sibelius) that has changed that in that they now do not have to be "progressing" but it has to still be ordered by a physician. Whether or not this is going to help LTC / NH type of patient is still to be seen. Personally I think the ruling is going to help those with MS, Parkinson's, secondary Polio's who used up their days under the old system to get more days and actually work against dementia patients as the MD just will not write the orders due to their dementia and not being able to be "cognitive & competent" for rehab. But I digress, so if he is not on Medicare, then his health insurance coverage will be critical in all this. If he has a significant co-pay for rehab, you all may have to put up some of this for him to continue to stay @ the facility.

Whatever you do, DO NOT sign off on any documents with your name & signature. Anything always has to be as "Jane Smith Jones as DPOA for Mary Smith". Ask clearly if after the initial rehab period, if he is not progressing and will need to be under LTC, will the facility accept him as a Medicaid Pending resident.

If it ends up being that he needs to stay, please see an elder law attorney asap. You mom as a "community spouse" has quite different rules for income & assets for dad to qualify for Medicaid. She does NOT have to impoverish herself for him to qualify. But if funds need to get move about it needs to be all done & cleared before dad applies for Medicaid. Medicaid for couples does this "snapshot" day set on the date of application and they kinda have to get money moved & cleared through the bank before then. Like say it looks like they need to spend-down 40K for dad to qualify for Medicaid and they still have a mortgage. So they pay 40K towards the mortgage, but this could take a bit of time to clear and be done - it's these sorts of things the elder law guy can steer you through. Otherwise Medicaid is assuming he can use the 40K for private pay before Medicaid will kick in. Oh also Medicaid allows for only 1 car but most couples have 2. If they gift 1 to grandkid there will be a penalty for doing that so what is better is to trade in both and get 1 more reliable newer car for mom "the community spouse" to have. it stuff like this that will drive you loco on Medicaid, so really elder attorney helps guide you through what works best for your state unless you are really good on "legalese" and governmental policy crap.

This site has a drop down list of elder law specialists by state too. Good luck, stay organized and keep a sense of humor in all this.