Have you been denied Medicare coverage because you were not "improving?" We need your story for our Medicare "Improvement Standard" Advocacy & Education Initiative
Tracey Keibler, an advocate from Minnesota, sent us this:
A few weeks ago, I received a call from a church member whose mother was soon to be released from a rehab facility because she was no longer improving (following surgery where the doctor ordered that she bear no weight on her leg for 90 days and receive PT, OT four times per day). She was told not only could she not stay in her rehab bed but neither could she private pay for the bed. If she wanted to stay in the facility, she would have to transfer to the long-term care SNF unit as a private pay patient; or, she could go elsewhere.
I went to your website and downloaded the Improvement Standard Self-help Packet and discussed it with the family. I was amazed at what happened next. When we spoke with the social worker, she admitted, "I don't know the Medicare regulations, I've never read them." The family was able to stand up for their mother's Medicare benefits by outlining, point by point from the self-help packet, the reasons why she met the skilled nursing care coverage criteria. The social worker quickly backed down from insisting that mother be moved out of the rehab bed within the next few days. She agreed to delay the decision to move the patient until after the follow-up appointment with the doctor a week later.
At the hospital, the family was able to effectively communicate with the doctor and his orders did not change (no weight, PT & OT 4x per day). To everyone's relief, the patient is still in the rehab bed. The extra 70 days in rehab will be covered by Medicare and the co-pay will covered by their supplement…this is a tremendous saving for this family.
If you have an Improvement Standard story of your own, please submit it today.
If you prefer, you may mail submissions to:
Center for Medicare Advocacy
P.O. Box 350
Willimantic, CT 06226
We thank you in advance for your contributions.
To archive this or other problems you have faced in getting health care, you can also visit the The Health Care Problems Archive. The Archive's mission is to collect accounts of problems with the U.S. health care system from people involved in every aspect of the system, in the belief that those trying to craft effective solutions must hear about human experiences, because statistics alone can never adequately capture the problems.