Medicare Managed Care Chronicles: After all, she’s 91… … (Part 5)
Mom’s PT documented that she was still progressing, that she
was still a fall risk, and that she was benefiting from the exercises and
activity. He noted that he had not yet released her to walk independently. He
indicated that she is alert and oriented and understands her limitations. He
said that statistically, a patient’s diagnostic level drops a level upon
discharge to home or assisted living, so discharging prematurely is dangerous.
Later in the day he called United Health, and was told that a denial had not been issued, that they were still
reviewing the case. That it was still pending. United Health redirected him to
the HMO, which confirmed that a denial had been issued. The rep would not
budge. She cited Mom’s age, and the
fact that they have a fixed amount of money, and Mom had spent that so she had
to be denied.
Given the multiplicity of mixed messages, we felt we had no
choice but to move Mom to assisted living. She was clearly not ready, but was
being forced to a lower level of care that she
has to pay for. She was discharged with orders to receive both home PT and OT two to three times per week in
assisted living. That didn’t happen. She had a few visits and is now being
discharged by home health. No one can tell me why. As a Medicare subscriber,
she has the right to receive care to
restore her to her prior level of functioning, as long as she is progressing. She
was progressing until she was denied that right by United Health and her HMO.
By June 7, I still had not received a decision on the “expedited
appeal,” now a week late. I called again and received terrible customer service
from United Health who gave me a lot of misinformation. I finally spoke to a helpful
supervisor, who offered to receive and forward a summary of my complaint. I wrote
up the entire sordid affair and forwarded it to him, but have had not official response.
Finally on June 8 I received a written confirmation of the denial--dated May
30!
It’s been a steep learning curve. Indeed, both private
insurance and Medicare are already throwing granny under the bus. The elderly
are not getting the care they have paid for and deserve. And we aren’t even
under Obamacare, which removed $500
billion from Medicare. Folks, we’ll be dealing with this type of ordeal for the
rest of our lives, fighting for care for both our parents and for us Boomers
who become eligible for Medicare over the next 20 years. If you’re old, don’t
expect to have your insurance cover you. Expect age discrimination. Expect to
spend many hours fighting coverage battles. And even if you are extremely
tenacious, expect to lose.
Photo Credit iStockphoto
Labels: elderly parents, HMO, Medicare, rehab, United Health
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