Medicare Mayhem
Welcome to America
Dad fell last weekend and wound up with eight stitches on his head. I think the paramedics must have been smoking weed when they rigged him up on the stretcher.
They figured out he had heart issues (which probably caused the fall) and he was transferred to another hospital so a pacemaker could be put in. All of this was new to us so there was a huge learning curve.
Plus of course, it’s emotional to have a loved one with continued medical problems. Then you add the lovely medical system which is sorely lacking in common sense and it’s enough to drive even the sanest person crazy.
I keep a medical journal for my dad. I am going to share just one day’s entry with you so you can share in the madness. Of course, I have changed the names to protect the guilty.
Wednesday:
Called the hospital to ask them to give the surgeon my phone number in case she saw Dad before I could get to the hospital.
The surgeon’s office called (Yay! She got my message!) and said that Dad should be ready for discharge sometime today
Called Assisted Living (where Dad now lives) to let them know Dad would need his stitches out.
They said, “We don’t do that there.”
I told them the ER Doc said that Assisted Living usually handles that. They said they would have to get back to me.
Also said they could help dad with getting dressed because his arm will be in a sling for six weeks but they would have to charge extra. (How kind of them!)
Called them again to ask why they need two weeks' notice to fill a prescription. I also asked about them taking the stitches out. She said she would voice my concerns to the correct people and then have them get back to me.
The Hospital Charge Nurse called; said Dad had been evaluated by PT and was unable to walk properly, even with a walker; he would not be released and needs rehab; crap! he will miss Thanksgiving 😦.
Social Worker from the hospital called; told her I had heard the news; she said the problem is that Medicare would not pay for rehab so it would be private pay; I asked why and she said he needs to have been in a hospital for 3 overnights to qualify.
I reminded her that had been transferred for the surgery from a different hospital so it had been more than 3 nights; she said the problem is that his status was “observation” which does not qualify; she was going to do some research and get back to me.
Called the original hospital’s president as I had met him the day before; his assistant answered; I told her the situation and asked if they could change his status; she said their Patient Advocate was on vacation this week.
I needed to call the Patient Advocate from the surgery hospital and she would communicate with the right person. (Has this given you a headache yet?)
Left a message for the Patient Advocate and paged her; continued to do so every 30 minutes.
Called the number I had for Medicare; 30-minute wait so I left a message
Patient Advocate called back; said the criteria for hospital status is very strict so it can’t just be changed; if they do, we could end up having to pay for the hospital stay too; said she was going to pull in Head of Discharge Planning from the first hospital to get a team together to try and find a solution
Social Security called back; I had the wrong number for Medicare; called the correct number for Medicare and they said that acute inpatient rehab (in a hospital) is covered by them and does not require a 3 day stay; sub-acute skilled nursing facility rehab is not covered without a 3 day hospital stay; I asked if there was an appeal process and she said no
Talked with Nurse about this information; she said Dad would not have the stamina for hospital rehab; it is at least 3 hours of intense therapy daily
President’s Assistant at the first hospital called back with another name because I had left a message for her saying the Patient Advocate hadn’t called back; I told her I didn’t need it and a team was working for us
Talked again with Nurse; she said that if I took Dad home with me, he would need to be watched 24/7; she could set up services at home if his primary doctor (who is at Assisted Living) would write the orders
Assisted Living Head Administrator called back to address my concerns; she said that express scripts requires time to deliver and that’s why it needs 2 weeks; I explained that wasn’t what I was talking about; I was referring to their own Assisted Living Doctor ordering scripts for Dad on the day I ask for them; it wasn’t happening
She said Dad would probably require assistance with dressing, shaving, etc. because of the sling for 6 weeks and I asked her for a ballpark rate of how much that would cost; also, explained that we needed orders for rehab if he came to my house; said she would have to call back
Nurse said the team made Dad’s status inpatient as of today; if he stays until Saturday, Medicare would pay for rehab
During all this time, Dad was extremely out of it; I found out he had taken a narcotic for the pain (which explains it; he reacts very strongly sometimes)
He was sitting in a chair, bent over sleeping; at one point he woke up and asked about the macular degeneration grid he uses for his eyes; I asked Nurse and she wasn’t familiar with it; I suggested she google it; she did and printed him up a grid.
Then it occurred to me that if he took the meds before the PT evaluation, that could have affected his walking; I talked to the staff but they insisted that he was alert and that had nothing to do with it; I disagreed, but there was nothing I could do about it so I dropped it
(Common sense tells me that if the meds had him drooling on himself for five hours, it probably affected his balance while walking, but I got the ‘ol “WE know cardiology patients” stuff… Well, I know my dad!!)
Social Worker called back; I had asked her to look into Dad’s secondary insurance; she did and they will not pay for rehab either; rehab is $490 a day and requires a 7-day advance payment before the start
I told her that the team had changed Dad’s status; she said no one kept her in the loop and that is not an option and we might also end up paying for the hospital stay; she said she would discuss things with the Discharge Planner from the first hospital and get back to me
My stomach is sick from this roller coaster. It’s resolved. No, it isn’t. It’s great. Now it is worse than before.
Welcome to medicine in America.
Assisted Living called back with the Administrator and Social Worker on the line; they said they felt that the best option for Dad was to be released to them and their Doc would write an order for rehab there
I (or family) would have to come at least twice a day to assist Dad with dressing, undressing or else we would have to pay; 2 showers a week is $150/mo; the rest would be $300/mo, ballparking about $450 extra a month; I said I would have to discuss this with the team and get back to them
Surgeon’s office called to set up a 2 week follow up appointment
Talked to Social Worker; said she is out of the loop now; Nurse is the one who will follow up
Nurse said that Surgeon noted Dad’s blood pressure dropped; this is a legitimate qualification for status as an inpatient stay; he will be moved to another part of the hospital in the general population vs. the cardiology unit; if he stays until Saturday, he will be eligible for rehab being paid for
(Now how is that for common sense? Now we are hoping dad DOESN’T get well so he has to stay in the hospital long enough so that insurance will pay for the services he needs!)
In between all of this, is the rest of my life.
All said and done, I sat on Thanksgiving morning and counted all the phone calls I had the day before, just for giggles. Wanna guess? 59!!!
No wonder I’m nutso…
But here is something nice. When I finally left the hospital last night, I was talking to my sister on the phone while I was walking to the parking garage. I was crying out of exhaustion and frustration. The Parking Dude told me I didn’t have to pay the 7 bucks that I usually have to pay for parking.
I told him, “Thank you and I plan to cry every night so you will let me off the hook.”
He smiled at me.
