She has spinal stenosis and in hospital - they want to send her home. She can't sit up, walk with out assist and is in tremendous pain. She would need care 24/7 and there is no one available to do that. They said she can't go to rehab because she is a "watch" not a regular patient. Not sure what that means.
I guess we were lucky because the change in obvs to adm was always approved.
We experienced this in 2012 when my father's pacemake was changed and we had to go to the electrophysiologist's preferred hospital, which had technology that his alternate hospital did not have. The issue was one of safely removing and replacing the pacer, and there was an ancillary issue of a defective defibrillator.
Dad developed CHF post-surgery; nurse practitioner said it was "probably due to overinfusion during the surgery". Because of the CHF, he was kept overnight, but I didn't realize the difference between admission and observation.
The hospital later billed him about $80 for meds, including outrageous charges like $14 for a lip balm which he couldn't use because it was petroleum based and he was on oxygen for the CHF.
Medicare refused to pay. I appealed and battled with the hospital and Medicare for about a year. Medicare dropped the ball and failed to respond after the second appellate level was reached.
The hospital also gave up. The $80 for about $15 worth of meds was never paid.
Linda, I don't know for sure whether you can appeal the discharge status, but I demanded explanations and was prepared to order the enter medical chart if the hospital didn't cooperate, which it eventually did.
But you can appeal any Medicare decision not to pay the meds. The outside deadline is listed in the Medicare EOB.
I think I was enough of a thorn in the side of the hospital staff that they just gave up.
Carmichael, I have no particular information on IV meds as a factor for requalifying an admission status, but ask the hospital, in writing (by e-mail if preferred) to document their policies, explain, etc.
But also contact her orthopedic doctor and ask for a script. You might be able to get around the hospital issue by taking your mother for an immediate visit post-discharge (i.e., directly after she's discharged). But better to try and resolve this before she's discharge since she wouldn't be able to stay home alone.
The other issue would be whether she's already used her Medicare "quota" of PT for this year.
http://www.aarp.org/health/medicare-insurance/info-08-2012/medicare-inpatient-vs-outpatient-under-observation.html
Keep on social services. Become their flea.
And note to all: Make sure your loved one is actually admitted into the hospital and not kept 'on observation' without admission. Those 3 days are magic.
Fight for pain control for your mom. That and contact social services in the hospital and tell them what you've told us. Don't remove your mom from the hospital.
There's Magic in those 3 hospital-stay days. Everyone should confirm with the hospital that their loved one has actually been ADMITTED and is not just being held for observation. I think they'll often do that if it's a RE-admission within thirty days.
Come to think of it, though, if it's BEEN less than thirty days after an at-lease 3-day stay in the hospital, mom would STILL be eligible for rehab.
You sorely need to get with the social services department at the hospital. Fast.
Are there other medical issues? Did she get admitted by ambulance and they were just observing her? You just have to question everything going on and demand good answers. Best of luck!