Wellness

[gidgetgh]

Just wondering if anyone on a Medicare Advantage plan has ever had to use inpatient rehab?

Without going into too much detail, a friend of mine's family member was admitted a few weeks ago to a rehab center, after a life altering illness and lengthy hospitalization.  The therapists evaluated this person and estimated a 3-4 month rehab. 

Yesterday, just a few weeks in, my friend was told that the insurance company is now balking and might only cover through next week.  This would leave my friend high and dry. My friend is of course, extremely upset and concerned and, to be honest, terrified. 

It's horrifying as the family member is in no way, shape or form able to come home. The rehab center said they're starting to experience problems more often with advantage plans covering lengthy rehab stays 

Anyone have experience with this?  My friend was going to meet with the rehab social worker again today to see if there is an appeals process or any other options. 

[fthunt]

Don't know much - but from what I've heard about M Advantage, I wouldn't be surprised about anything.  I got tricked into signing up for it and when my doctor's wife found out about it - - she had a fit.    I finally got out of it and back to what I had.  Good Luck to your friend.

[gracie2014]

Wow, how unfair! I had something pretty much similar happen to me last year...they can discharge without notice...my question is have they made discharge plans? Has anyone gone to the home to make sure everything is in place for the family member..so sad that people who are unable to advocate for themselves are put in this position..the rehab my mom stayed in discharged her without notice..we were given one date and they discharged her about a month earlier when we had returned home to pick up a few things and close up shop..she had experienced a stroke and cardiac arrest at the same time....the plan was for her home to become accessible...with a ramp,etc...they discharged her into my sister's care..they saw that my sister's husband was handicapped...but it was a brain injury...there was no way for her to take a real bath...a study was converted into a bedroom..it was truly awful....I would go to the head of the insurance company...there are others who can help out. Praying they work something out.

[Kachina624]

I have a Medicare Advantage Plan and was in a rehab facility 2 weeks after knee replacement surgery in 2011.   I didn't pay a penny.  

Your friend should have received information from her carrier regarding her coverage, which may be different from mine.  Not all Advantage Plans are the same.  Why doesn't she call her company and discuss it with a representative?   They would be able to tell her what the limit of her coverage is and how she would appeal a decision with which she disagrees. 

[Kachina624]

@fthunt  My Advantage Plan has been absolutely wonderful.  I've had it about 8 years, see the doctors and specialists of my choice, go to the hospital of my choice, and have had knee replacement surgery.  I've never paid a single cent out of pocket.  How could it possibly be any better? 

[gidgetgh]

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@Kachina624 wrote:

I have a Medicare Advantage Plan and was in a rehab facility 2 weeks after knee replacement surgery in 2011.   I didn't pay a penny.  

Your friend should have received information from her carrier regarding her coverage, which may be different from mine.  Not all Advantage Plans are the same.  Why doesn't she call her company and discuss it with a representative?   They would be able to tell her what the limit of her coverage is and how she would appeal a decision with which she disagrees. 

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Thanks. This happened very late yesterday afternoon and I spoke with my friend early this morning. They were going to spring into action today. 

[gracie2014]

Not sure @Kachina624...actually yes I do!!!! My dad did not think my mom was going to survive so to save $35 a month which would have covered the rehab facility, he chose to not opt for that choice. He was a retired federal employee with excellent insurance...

[gidgetgh]

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@gracie2014 wrote:

Wow, how unfair! I had something pretty much similar happen to me last year...they can discharge without notice...my question is have they made discharge plans? Has anyone gone to the home to make sure everything is in place for the family member..so sad that people who are unable to advocate for themselves are put in this position..the rehab my mom stayed in discharged her without notice..we were given one date and they discharged her about a month earlier when we had returned home to pick up a few things and close up shop..she had experienced a stroke and cardiac arrest at the same time....the plan was for her home to become accessible...with a ramp,etc...they discharged her into my sister's care..they saw that my sister's husband was handicapped...but it was a brain injury...there was no way for her to take a real bath...a study was converted into a bedroom..it was truly awful....I would go to the head of the insurance company...there are others who can help out. Praying they work something out.

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My friend doesn't have an end game plan yet because it depends on the success of the rehab. There's a goal certainly of coming home. But no way could that happen now. 

[conlt]

I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage. 

[gracie2014]

Praying for this person!