Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?
Last month my father fell and went to the ER then on to rehab. It was work to find a rehab that would take anyone at this point. He stayed for 40 days which took him through 100% coverage and 80% coverage. AL required two negative Covid tests before re-admittance. His first test was on the 1st and it was negative. The first issue was rehab dropped the ball and did not retest him until the 16th for a 19th discharge date. Test results did not come back in time and they told me if he had to spend the weekend it would be at 100% self pay. At $500 a day I was not happy. Test results come in late on the 19th and they are positive. He has been moved to their covid wing but I haven't received a confirmation that his extended stay will be covered by Medicare. One person said it was covered and another wasn't sure. It is assumed he will be there for most of July and we cannot afford $500 a day especially when they are responsible for his exposure.
Has anyone else had experience with this? Is it covered?
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Now I am not sure about this, but Dad has 60 days out of the 100 unused? Not sure if he would be entitled to 100% coverage but at least the 50%. I would call Medicare and run this by them. I guess since they couldn't readmit, Medicare will not cover those two days?
https://www.medicarerights.org/medicare-watch/2020/05/12/what-you-need-to-know-about-coronavirus-and-medicare-coverage
From Medicare.gov:
State Health Insurance Assistance Programs (SHIPs)
SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. SHIPs can help you with things like:
Your Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance
Complaints and appeals
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Find contact information for your state's SHIP
https://www.elderlawanswers.com/medicares-limited-nursing-home-coverage-12131
After that your dad will be responsible for 50 percent of the daily amount from days 21 to 100.
He is covered for 100 days, but only the first 20 days are covered at 100 percent.
I am going through this with my dad. Just got first bill for days not covered at 100 percent.
It adds up quick.
Even though he was approved for additional rehab past 20 days, in fact it was recommended by the facility, bills mounted up quickly because only a portion was covered.
Now with catching Covid while he was in rehab, you may have some recourse. Could he be moved to a hospital where he would be covered by insurance due to being a medical patient, not a rehab patient?
Might be the best course of action.
for three days or more, his 100 days of Medicare coverage can kick in again. But how do you get your dad in the hospital is the question. Don’t think his current condition would qualify, however watch for other related conditions like pneumonia. A health insurance agent gave me about the best advice. When it’s time to enroll in new plans, apply for Medicare Advantage as mentioned in another response, he cannot be denied coverage. But I will
be watching for more answers as no one taught us anything about joe to navigate through all
this bureaucracy.
as it is an acute pneumonia that resolves. The inhalers provide treatment for SOB. I doubt long term Oxygen will be ordered yet approved. The inhalers are meant to improve Oxygen sat %. O2 sats (saturation) are usually back to baseline after Covid. Justification for Oxygen paid for by Medicare at home requires O2 sat values measured while sitting & walking and PFT’s. Not gonna happen post Covid. No medical need.
The post Covid person is then referred to their PCPand/or Pulmonolgy for Covid follow up (CT/Chest done on an interval - baseline post DC on out patient basis then another in 2-3 months & Antibody testing post hospital discharge. The pneumonia is expected to and does resolve.
I work in the field and this is what I am seeing.
In the past I have spent hours on the phone with his insurance just getting more and more frustrated. I think things are settled and then find out they aren't.
I am appalled that the rehab facility will even consider charging us full price for days my father had to spend there because he caught the virus in their facility.
You don't even know where to look for answers because everyone I have dealt with in the past has given me bad info. I'm just going to wait until the hospital tells me what the ling term outlook is for my father then ask for one of their social workers to work on a solution that we can all live with.
I suspect none of the major insurance providers Customer service reps will even be able to give you the same answer about coverage during Covid twice.
You can periodically go to the insurance Provider’s website for the “latest” guidelines. An early action was waiving copays & deductibles for C19 in the acute phase but as far as follow up, it’s a work in progress.
Then if you don’t agree with their decision appeal it. You have a pretty good case to prevail. Not your LO’s fault he and you were confronted with a major pandemic after all.
Good luck to you and I bet it all works out!
CDC experts took this pandemic day by day. LTC centers followed the leads and laws set by states and the feds when there were no scientific guidelines due to the mutation of the virus.
Catch 22 situation.
I am trying to find a place that he can 'afford' on private pay for a period of time. While all will take Medicaid, my father helped out grand kids with funds for college 3-4 years ago before he went to AL and anyone knew anything about Medicaid. So now we have that problem. I am sick with worry that his one and only nice gesture will come back and bite me in the butt.
The last thing in this world I ever wanted to see was my father in a nursing home, bedridden. But that looks like where we are headed. At this rate I will pass before he does.
Medicare may not yet have made a definitive decision about how to handle this situation yet. My suggestion would be not to pay anything to the rehab facility until you see something from Medicare. His rent at the AL must be paid if there is a chance of him returning but you need to look at the reality of that. ALs don't provide a lot of service just "assistance". Can Dad live at this level of low care now?
Since Dad has had to stay in rehab for the extra days because of the pandemic, does he need (and can he participate in ) more rehab? If he does and can participate, charges will likely roll back under Medicare (traditional)'s 20/80 rule as he has only used 40 days of his 100 day time set. Good Luck
The rehab did bill me for the last 5 days he spent there at full price. It was less than I thought but I still don't think I should have to pay 100% of this. Called the insurance rep who had reached out to me before. She is incredible. She told the rehab to apply for a covid related extension. Said she will call when that happens and to not pay the bill I have. Gave me the names and number of the people she talked to. I have never worked with someone so helpful before.
My father passed from Covid on the 11th.