Primary Medicare B vs. Awesome Secondary Insurance - Medicare blocks great insurance.
Hi, has anyone else run into this???!
My father entered the hospital about 8 days ago at the ultimatum insisting from his primary care doctor - that he had to go in for treatment for severe intestinal cramping and not being able to produce "results".
CAT-SCANS showed 1. infection, 2. hernias. He was put on morphine - that didn't work so they upped it to percoset highest dose.
Still has infection.
Still has pain but now pain is blocked somewhat with drugs.
Still can't get :results" on his own with his bowels.
Hospital discharged him - -straight to home --- to DRIVE HIMSELF HOME (he's 93) with opiates still in his system.They "considered" sending him to an extended medical place but since the social worker told them that he can "feed himself", "dress himself", and "bathe" - Medicare B won't cover the stay. Without Medicare B willing to cover it, the secondary insurance doesn't have to cover it either - whereas if Medicare would cover it, secondary would cover the rest in full. His insurance is amazing - top of the line - old style plan from a nice retirement package.
So he's released and on his own to take care of his pain, manage meds, and drive himself here or there.
(Oh - and the trick knee that keeps buckling on him - the hospital's answer was a shot of cortisone - only - no knee brace, or anything.)
Is this "normal" quality of care in a US hospital??? If this is, gee - find your passports quick and consider emmigrating. The Canadian medical and aftercare system is far better and free. I moved back several years ago. How do you release a 93 year old from a hospital stay to drive himself home, with opiates still in his system, who can't generate his own bowels to move, with a flourishing infection????
Does this sound nuts? Or am I off-base? Why are people falling through the cracks from going to extended care when there is a "medical need" vs. just needing "care supports"?
Was told he can't qualify for a Rehab in hospital (vs. Skilled Rehab and Long Term Services in an off property program) since he did not have an ortho diagnosed problem - bad knee doesn't count, nor has he had a neuro issue, like a stroke. So, he has to be ousted to go elsewhere.
Learned Medicare B does apparently block ALL insurance, no matter how great it is, if the person is retired. They must use Medicare. Supposedly it is better than insurance. I don't know. I just know Medicare won't kick in if he can eat, dress himself and walk. Insurance can deny coverage if Medicare won't help in first position.
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LATEST ON A FACILITY: This is my third contract over 30 pages I have reviewed that tried to seize assets and have you sign away rights for third parties persons. The contract, for what is supposedly the BEST of all facilities in the metro area, was so riddled with typos and other grammar errors, it wouldn't have passed a high school English class. Contract was a mess! Also had legal clauses contradicting the other. Further didn't list costs and wanted to have me sign a "blank check".
Boy - anyone listening -- READ CAREFULLY --- and get the contracts early. If you don't understand what you are reading, then take to a lawyer or nonprofit serving seniors, or other advocacy group.
These places seem to hope you won't read it, or are so emotionally a mess that you won't focus to read carefully. With a strike of your pen, you could be signing off on all the assets of the Patient.
AND - get this their "definition" of "Responsible Party" - is the BOOKKEEPER!!!!
WATCH WHAT YOU SIGN. You could be on the hook financially for just paying a friend or family members bills for them as a favour.
Hospital wants to turn him out tomorrow. Decided apparently on no surgery according to the 3rd yr resident. Waiting to talk to primary doc.
He got a ride home. Within hours of being home, he fell three times. Over night, he fell another two times. Neighbor called 911 and they took him back to same hospital.
He's still in hospital now and they aren't too sure what they are doing yet.
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Meanwhile he has two ladies "circling" waiting for him to be on his deathbed. So, I am trying to do "asset protection" as well.
He's not near death but he might need surgery.
Annoying when Black Widows show up ready to pounce! Ones a nurse at the hospital I have to report - see next posting. The other is a woman who only surfaces when she thinks he's about to die.
Ugh!
Inpatient docs normally sign out cases to each other and cover for designated periods of time - usually this is fine if they are attentive and make sure each new person has all the details they need to know. It can certainly be difficult to get all the relevant medical details long-distance, but at least you got them to talk with you.
"Yes" - forgot to mention he has been on antibiotics for about a week. CAT-SCAN wasn't showing any notable improvement. Head nurses this week have been consistently saying "no improvement showing in the CAT-SCAN" - yet 3rd year Resident today says there "is" improvement - looking at the same CAT-SCAN - - so I don't know if the doc(s) found someone who would give them a comment they liked, or whether the other notes in the chart are wrong. To me, if he can't do a bowel movement without an enema, there's no improvement. He already had bowel sounds when he went into the hospital.
Do I think he refused other interventions? Not sure. They may have scared him off from surgery. But he keeps saying he is ready to die and donate his body to science (has wanted to for decades) but maybe faced with the possibly "this is it - maybe" factor he might have freaked a bit. Most people would.
I just can't figure out how a doctor other than the one who admitted him, is able to discharge him. He got bounced from his primary care doc, to another associate, who dumped him on an immigrant doc who seems to have difficulty speaking English (probably is a great doc - just I don't speak his language. He was trying with me on the phone, seemed like a kind man.) 3rd year Resident was nice but was trying to pull a "power play" on me. When I brought up "possibly liability for the hospital if he allows him to drive home on opiates(!)" - he sort of backed down and said he might consider getting him a taxi.
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About six months ago, my girlfriend was in extended care for healing up a broken hip after surgery. The person in the bed next to hers, older lady in her 80s, was sent home with an infection. A day later she was dead. My friend kept trying to tell the family and visiting random doctor that the woman was in pain. She didn't always speak coherently. But she cried a lot in pain - I even saw that.
I don't want the same to happen with my father.
A nurse checking in for like 15 minutes every couple days is just not enough.
I know he was anxious to get home. House is up for sale and he likes being there when people tour with an RE Agent. (Of course the agents wish he is not there.) On one hands its good as they might find him and be able to get 911 called, but otherwise, he could be a distraction and hurt his bigger goal to get the house sold.
It was annoying Resident kept saying "You have to get LOCAL family involved."
I don't know how many times I repeated - he has NO LOCAL FAMILY.
So much for great insurance... this seems so sad. Canada just seems to treat elderly (and senior) people - kids - and people in general way better.
Even in a bascially good system, bascially good people can be fooled into thinking things are more OK than they are, and thoughtful - but firm - advocacy is often critical for patients who may not be able or willing to speak up for themselves or come clean about what is really going on.