My mom, 78, who is in a wheel chair becasue of unseccessful back surgeries can't walk. She lives at home by herself and had been transfering herself from the wheelchair to the bed/couch as needed. She recently feel and hurt her leg. We took her to the hospital and they said she had broken her fibia, but they never admitted her. After a ccouple days in the hospital under "observation" they released her with a brace but she couldn't move herself at all because of the fracture. So we set her up in a nursing home. We find out that we have to pay out of pocket becasue she was never "admitted" be the hospital. Does anyone know if we can disput after the fact that she should have been admitted so we can utilize medicaid?
If serious enough and/or certain conditions exist, direct admittance will be done. Otherwise, it's an observational status.
Determination whether to change from observational status to admitted is made after 23 hours.
In another situation, I did challenge after the fact after being billed by the hospital (not the good one we normally use) for an outrageous sum of grossly inflated medicines. The different levels of staff with whom I spoke were trying to be helpful, but the inference was that no change could be made in status after the fact.
I don't know whether you have Medicare and Medicaid, but in case you're not aware, Medicare does not pay for meds administered while under observational status, but these meds are limited to those which could be used at home....i.e., if the patient had surgery, the anesthesia would be paid for but something like Tylenol or aspirin wouldn't be.
The theory is that people purchase part D of Medicare and that pays for meds.
I raise this issue just so you won't be surprised if your mother is billed directly for meds, but you don't have to automatically pay. I challenged a hospital and filed appeals up to the second level with Medicare. Eventually the hospital gave up and absorbed the costs (which were greatly inflated).
I'm not familiar with Medicaid rules on rehab facility admission, but I think once the chart has been noted as to observational status, it's illegal to go back and change entries.
However, I don't understand that given your mother's physical limitation, how she could have been discharged without any followup care plan.
Was any surgery done on the fracture? If she can't move, how did the doctors involved expect her to move around at home?
I would at least contact them and ask for a script for home therapy.
Can your mother get home care? That might be easier for her in the long run.
Did your Mom see an Orthopedic doctor after she was released from the hospital. Wonder if that doctor could have written a script saying Mom needed nursing home care?
With Medicaid, there must be certain step by step rules to follow.