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.
Not every inpatient rehabilitation facility accepts Medicare. You should clarify that they do indeed take Medicare and then request the hospital call while you are present. My dad didn't qualify for in patient rehab because he needed help with activities of daily living that they didn't provide.
My dad went to SNF for rehab and had great results. He was in rehab multiple times daily, 6 days a week. He was also encouraged to walk around the facility multiple times a day. He was getting at least 3 hours daily of rehab. He went from being able to transfer from wheelchair to bed to walking the halls.
If the facility excepts Medicare they might not be in the network for a Medicare Advantage. You need to ask if Mom is on straight Medicare with a supplement or a Medicare Advantage.
Medicare Advantages are HMOs or PPOs. Both work within a network. The difference is PPOs may allow out of network but will pay more if you remain in network.
What u need to ask the Discharge nurse/clerk is what does she mean about network. She maybe under the assumption ur insurance savy (not saying u aren't) and really u have no idea how Moms insurance works.
Believe me with all the different plans out there and all depending on the amt ur willing to pay out monthly its so confusing. My Dads employer made it mandatory for retirees to buy from an exchange. Some of these people were in their 80s. Previously all they did was show their Aetna card and that was it. There was no network. They had no idea what that meant. I did, because my DHs insurance was in network. I had no problem switching Mom. My problem is educating my DH.
Just throwing out a thought.
Stepdad at 84 went to rehab following a hip replacement.
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.
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.
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.