The physician should be able to change his status to full admit and then Medicare should cover after the change. He should be able stay until he is seen by this second Neuorlogist. I think his Primary is the key to your problem.
Have you talked to anyone from administration about this problem?
The second neurologist has concluded that it is the disease that is my father's problem, as if I did not already know, and has upped his Aricept from 5 to 10Mg to improve cognition. Today, when I visited my father, I observed that my father experienced some type of seizure as they were taking him for an MRI. I think this new neurologist is missing the boat, and I need to bring in another. The primary is hoping that the MRI will find something which in turn can change his admittance status. In the meantime, the primary reiterated again today that it was the hospital that changed the admittance status of my father. When I originally spoke to Patient Relations, they kept quoting Medicare Guidelines. I need to escalate this further.
Parkinson's when it becomes difficult to respond to treatment might need a further specialist. I know people with Parkinson's who have benefited from a consult with a movement disorders specialist. There are some hospitals that specialize in this area. Perhaps he could be referred to one and they could provide appropriate recommendations as to treatment. There can also be concerns about medication side effects and interactions (and of course other medication options) but a specifically trained movement disorders specialist would be the best person to speak to.
Agreed but the next most pressing problem for me is knowing that a Hospital can override how you are admitted by a Doctor precluding you from certain treatments if you are a Medicare recipient. Since when in history did one ever have to question the category by which a doctor admits you to determine whether the hospital will be paid at the expense of life-saving minutes? When your in an ER, you should not have to think about this at all because you are putting full trust in the doctor's admission criteria. There is a bad precedent being established.
Well, has your father gotten the MRI yet? Is he still in the hospital?
I am kinda confused. Has the hospital's social worker/case manager done anything for you?
The MRI results are negative. My father is still in the hospital. The Primary is ordering more tests because of the seizure, also hoping that this would make the hospital change the status. If so, he is Nursing Home eligible.
On the other hand, I spoke to one of the Hospital Administrators. He told me that everyhthing is driven by what meets Medicare criteria.
In the meantime, the Home Care that I had previously arranged for him told me that if they evaluate him for reinstatement and find he is unsafe and/or unstable, they cannot admit him. I informed the Primary and the Hospital Administrator about this. The Primary tells me do not worry, the Administrator tells me to Private Pay or seek charity care. I told both the number one concern is the health of my father.
Hopefully, this status will be changed. Geez, you are having a time with all of this.
Does your father only receive Medicare?
Have you talked with anyone from Medicare yourself? Something does not sound correct.
In my opinion, he was nursing eligible before he even went into the hopsital. I tell you Medicare changes their regulations and rules so often.
As an American, I can say this is appalling.
This hospital didn't give you any other resources that may be able to help?
Have you called around to different facilities on your own that may be able to take him?
As of today, I was informed by the PCP that in a X-Ray, they detected some pneumonia in a lung. Being that this is an acute condition, treated with IV antibiotic, this should more than likely change the admittance classification to acute after three days, making him Nursing Home eligible. However, the hospital has to do their classification check with Medicare.
I met the Medical Coordinator from his floor today by accident who is working behind the scenes with Medicare in regard to this problem. No one revealed her existence to me but it give me a chance to voice my concerns, and what I would like to see at least. She came across that the hospital is really trying to help but the PCP's constant harping on the hospitals refusal to classify the admittance as acute painted the hospital in a negative light.
My father besides Medicare, has a secondary, and tertiary insurance however they only pick up after Medicare. It boils down to the category of admittance. I have now been told that some hospitals now turn patients away at the ER level from admittance because the patient does not qualify for acute treatment according to Medicare guidelines. They have procedures in place for this purpose but this hospital does not have such as system in place yet, so we face this dilemma.
Everything is predicated on Medicare guidelines according to every facility I called so far.
What is needed is some type of Ombudsman for people in my situation. Some doctor who is willing to consult, and/or intercede on the family's behalf with other doctors, at the family's request to help with diagnosis, and treatment. Not a hospital advocate but a family advocate.
I find myself acting more like the doctor's should, and I am not a doctor.
By the way, there is no one that you can talk with at Medicare when the classification is Observation. When it is Acute, you have the right to appeal the discharge if you choose. If you do call Medicare, you wind up talking to a clerk who reads from the Medicare manual.