lliang_chi
Ideal_Rock
- Joined
- Mar 13, 2008
- Messages
- 3,740
Hey Charbie,
I know you work on the administration side of a nursing home. Not sure if it's admittance or what.
Background: my MIL has been recovering from an accident since January. She was released from the hospital to a skilled nursing facility for 90 days, then transferred to a rehab hospital for a few weeks, then discharged from the rehab hospital 5 days ago for surgery and is now recovering post surgery in the same hospital her procedure was done. We're trying to get her back into the skilled nursing facility she was in before (she still has 10 days left of her 100 days), but we're having trouble getting insurance to sigh off. Her surgeon has written a doctor's order that she should be released to a skilled nursing facility, and then eventually transfer home. However the insurance is denying admittance. My DH thinks it's because the rehab hospital might have discharged her as a "discharge to home", so the insurance company might be holding onto those discharge papers, saying she's ready to go home, she doesn't need skilled nursing
I think she isn't far from being ready to go home, but we'd just prefer to have her in a skilled nursing facility until she fully recovers from surgery then come home.
Anyway, my question to you,
1. Is there anything we can do to change the insurance decision? Insurance has the doctors' orders that MIL should go to skilled nursing. We're going to try to get the hospital therapists to say she also needs therapy, as an additional argument.
2. If we pay for skilled nursing out of pocket, what else are possible charges on top of room and board? E.g. are nurses visits charged? Doctors visits? Supplies?
3. If we pay for the skilled nursing out of pocket, will that effect how much Medicare will pay for her home care once she's ready to transfer home?
Thanks,
LC
I know you work on the administration side of a nursing home. Not sure if it's admittance or what.
Background: my MIL has been recovering from an accident since January. She was released from the hospital to a skilled nursing facility for 90 days, then transferred to a rehab hospital for a few weeks, then discharged from the rehab hospital 5 days ago for surgery and is now recovering post surgery in the same hospital her procedure was done. We're trying to get her back into the skilled nursing facility she was in before (she still has 10 days left of her 100 days), but we're having trouble getting insurance to sigh off. Her surgeon has written a doctor's order that she should be released to a skilled nursing facility, and then eventually transfer home. However the insurance is denying admittance. My DH thinks it's because the rehab hospital might have discharged her as a "discharge to home", so the insurance company might be holding onto those discharge papers, saying she's ready to go home, she doesn't need skilled nursing
I think she isn't far from being ready to go home, but we'd just prefer to have her in a skilled nursing facility until she fully recovers from surgery then come home.
Anyway, my question to you,
1. Is there anything we can do to change the insurance decision? Insurance has the doctors' orders that MIL should go to skilled nursing. We're going to try to get the hospital therapists to say she also needs therapy, as an additional argument.
2. If we pay for skilled nursing out of pocket, what else are possible charges on top of room and board? E.g. are nurses visits charged? Doctors visits? Supplies?
3. If we pay for the skilled nursing out of pocket, will that effect how much Medicare will pay for her home care once she's ready to transfer home?
Thanks,
LC