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A local hospital is insisting that my grandmother discharge to a skilled nursing facility even though she has met Medicare criteria for inpatient rehab admission. We even have an order from the doctor for discharge to inpatient rehab. We've stated what rehab provider we would like to consult, but the discharge planner has told us that the provider would not accept my grandmother and that the provider is out of my grandmother's network... but my grandmother has Medicare. There is no network. As of today, the rehab provider we prefer still has not been consulted by my grandmother's case manager. Is this hospital operating within CMS guidelines with this type of behavior? What can we or the rehab provider we've chosen do about this. Our preferred rehab provider has explained that they can not become involved in my grandmother's care unless they are called by hospital staff to do so.

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Sometimes groups of doctors own nursing and rehab facilities.

Stepdad was sent to one of those, as it was recommended by the hospital. The care was awful, so got him out and into another facility, not owned by doctors but by a large corporation. Care was much better, brighter and modernized.
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Skilled nursing is rehab. Rehab is not done in a hospital. Maybe preferred place does not have all the therapies grandma needs?
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FloridaDD Feb 2020
IME, the difference is that the hospital wing rehab gives MUCH better rehab, but would not take my mom after she could no longer do 3 hours a DAY of rehab.  When she was younger, she did qualify for the hospital wing rehab (in Atlanta), as did one of my co-workers in NY (really good hospital).   Now my mom is older and cannot do 3 hours of day of rehab and her choice was SNF or we could take her home and PT/OT would come to our home, for about 3 hours week, same as it would be in SNF
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ABSLAN, stand over them and insist that they call. That is what you do.

I am here because you are not providing me with information that makes sense. Call the rehabilitation facility right now and get them moving on getting my loved one set up. Yes, right now, here's the number and the name of the person that you need to speak with. Yes, pick up the phone and call, right now. Or I am happy to get them on the phone, here let's use my cellphone.

That is what you do.
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Call all the places you are interested in yourself and see what they have to say. Sometimes discharge planners send people to the place that is easiest for them to coordinate and not what is best.
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If you are dealing with the same person, ask for the supervisor and tell him/her you need an explanation why they are not following thru. I may also get the discharging doctor involved. Call his office and speak at least to his office manager. Be the squeaky wheel.
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When my mom did rehab we were given the opportunity to choose the provider. My mom also has Medicare and a supplemental insurance.

I do not understand why you would not be able to select where you choose to go. I would insist on your first choice.

I would enlist the help of her social worker and her primary doctor if I had to. Have them join forces with you for an added push.

Best wishes to you and your mom.
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Just read your response. Call Medicare. Tell them the situation and see what they say.
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Would it matter if your grandma doesn’t have a secondary insurance? Medicare pays 100% but not for the entire stay after 21 days.
Just throwing out a thought.
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JoAnn29 Feb 2020
They only pay 100% for 20 days. 50% 21 to 100 days. Suppliments do matter if u have Medicare Advantage. Whhole different ballpark. This is why I won't have one.
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Inpatient rehabilitation hospital care-Examples of common conditions that may qualify you for care in a rehabilitation hospital include stroke, spinal cord injury, and brain injury. You may not qualify for care if, as an example, you are recovering from hip or knee replacement and have no other complicating condition. More information-https://www.medicareinteractive.org/get-answers/medicare-covered-services/inpatient-hospital-services/inpatient-rehabilitation-hospital-care.
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Well? What has happened?
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