The insurance company is trying to kick my mother in law out of the nursing home.

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Trevin1337 Asked August 2016

The insurance company is trying to kick my mother in law out of the nursing home.

Basically whats happening is that the insurance company is trying to kick her out of the nursing home she is in. She recently suffered from a stroke and went into a coma, but she woke up and is coherent. She still needs recovery and can only move her arms and head but the doctors/nurses say she'll make a full recovery with time. The insurance company on the other hand has said she has made no recovery on the basis that she still has a feeding tube and tracheostomy in her. Were running out of options and have a social worker working out case but they denied our first appeal I was wondering what else we could do so we could afford to keep her at the nursing home until she's recovered.

Skilled Nursing Facility

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score 1 · Answer 1

Well based on what you've posted it seems a no-brainer - I assume you have written statements from her clinical team, recording her progress to date and their positive prognosis? All I can add is to wish you the best of luck with the appeal - please let us know how you get on.

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score 1 · Answer 2

The insurance would pay for 180 days but then they recently changed there mind on it, and are saying she isn't making any progress when she is. after 180 days she'd be evaluated but it hasnt been 180 days. We don't have at home care for her and my father in law would basically have to retire to take care of her. And we don't have the skills to do it ourselves obviously. But were putting in a second appeal today.

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score 0 · Answer 3

So what is the limit on the length of stay in rehab under her policy? This isn't my area at all, but as I vaguely remember it do you not get six to eight weeks of rehab and then transfer to long term care? Can rehab go on indefinitely even if the recovery will be very long drawn out?

What care and therapies would be available to her at home? Who would be her main caregiver?

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score 0 · Answer 4

They say that she should be brought home. Its only been a month since shes been undergoing rehab. And shes 49.

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score 0 · Answer 5

Trevino, how old is your mother? And to repeat: where does the insurance company say she should be transferred to? Say you are not able to mount a successful appeal: what are the alternative options for your mother's care?

You say the doctors/nurses say that in time your mother will make a full recovery. How long has she been undergoing rehab, please?

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score 0 · Answer 6

They argue that she isn't making progress because she still has a feeding tube and a trach in. But she is making progress before she went in when she woke up she couldn't even move but since being in the facility and going through the rehab there she can move her arms and head and feet now before that she couldn't move anything except her eyes

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score 1 · Answer 7

Is she in rehab, and not making progress?

If she needs long term care and can't afford to pay for it from her own funds, and does not have long term care insurance, one option is to apply for medicaid. She might be able to stay in the facility "medicaid pending". Ask the social worker if that is an option.

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score 0 · Answer 8

I assume the insurance company believes that your MIL needs a different sort of care, ideally one her insurance doesn't cover, yes?

Where do they argue she ought to be discharged to from the NH?

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The insurance company is trying to kick my mother in law out of the nursing home.

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