Sometimes I Feel Like a Piece of Bologna

Tuesday, June 26, 2012

Medicare Managed Care Chronicles: After all, she’s 91… … (Part 2)

We waited all weekend for a response. Did we need to move her or not? It was a time of uncertainty, which caused her blood pressure to rise and her progress to regress a bit. The rehab facility staff said the delay was unusual. Responses to appeals were usually received quickly, usually within the hour. We were at a loss to know what to do. It was a holiday weekend. No one could answer any questions. Her discharge date was scheduled for Memorial Day. We had made arrangements with Assisted Living, but they could not receive her on the holiday.

We didn’t receive any response until two days after Memorial Day, on May 30 at 4:00 pm when staff informed me that they had received a verbal denial. I called HSAG again. The rep said that the earlier denial would stand. The last covered day would be May 30 (today). I asked her the reason for the denial. She said that the patient was medically stable and ambulating independently for 200 feet. This was not true and not what the record said. The rep said that they had determined that she had hit her plateau. “After all, she is 91.”

Photo Credit iStockphoto 

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