Yes, if the senior was admitted to a hospital for 3 days, he was entitled to 100 days of coverage of Medicare A, of which the last 80 days has a co-pay.Looking for advice from experienced people with elder care insurance.
A relative has her sick senior dad in rehab after he suffered a stroke. He has been there for a few months and now the insurance won’t pay for any further treatment/stays. He needs care as his face is paralyzed now, he can’t speak clearly, and they are injecting iron in his blood every day.
Since the insurance is not going to approve his stay beyond tomorrow, they decided to then call 911 once he’s home and ask that he get sent to the hospital, hopefully they keep him 3 days and then we can get him in another rehab. The 3 day hospital stay is what she was told was required prior to being sent to another rehab.
They submitted an appeal with the insurance and it was denied because they say that he has reached his goals. Yet he can’t speak, he can’t move or even feed himself.
What would you suggest they do?
Since you mentioned that the insurance is denying further coverage, the situation indicates 1) he has not entitled to Medicare A when he had his stroke because he was not admitted to hospital after his stroke, or 2) he has a Medicare Advantage Plan. Action under each option would be different.
I don't know your definition of "a few months". If it more than 100 days after the stroke, Medicare A is no longer responsible, even if he was admitted to a hospital for 3 days for more after his stroke.
It seems to me, you senior requires long-term custodial care, which is not covered by Medicare. Your senior's situation seems to require self-funding of long-term care or a long-term care insurance policy.
Statistics: Posted by chemocean — Wed Aug 14, 2024 7:36 pm — Replies 4 — Views 147