Sometimes I Feel Like a Piece of Bologna

Friday, June 29, 2012

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  

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