Medicare Part A Pickle

[somarco]

She really can't leave unless she wants to go AMA

Unless the SNF can provide acute care (she is in ICU) the SNF is off the table.

Current legal address is still Georgia

IDK if she has $3k to fund the MSA or not. Seems to be a moot point when she runs out of hospital benefits in about a week.

I have not broached the hospice idea with her. She can be very combative (even in an email). On more than one occasion she has fired me in the past then came back begging. This was before Obamacare and before she got sick.

 

[kgmom219]

There's only one Social Worker in the entire hospital? Bull

Spitballing here...who told her about the days? And is there any family, specifically, who has the POA? Whoever told her about the days needs to figure this out. They can get her to Georgia. Or they can eat the cost. They aren't going to dump her on the street.

 

[somarco]

here's only one Social Worker in the entire hospital? Bull

Hard to say. She is at NIH. A hospital with 234 beds. How many SW's would you think they have?

who told her about the days?

Hospital business office and her PCP.

And is there any family, specifically, who has the POA?

Divorced. Not on speaking terms with ex or her children. Ex is in ATL, kids are somewhere else ????

They can get her to Georgia. Or they can eat the cost.

Air ambulance in her case is not medically necessary. Moving to another hospital does not reboot the Part A unless she is out of the hospital for 60 days. No way that is going to happen.

EMTALA (guess that applies here) will probably prevent them from kicking her to the curb.

 

[rmhaire]

EMTALA by itself probably won't apply in her case. EMTALA technically ends once the patient is stabilized. Most likely scenario could be a transfer to some type of charity hospital or nursing home.

She needs to start talking about Medicaid and/or Hospice. Anyone that's burned through 90 days in the hospital probably ain't going to get better.

 

[somarco]

I don't know what the medical definition of "stabilized" is, but anyone in ICU, hooked up to monitors, is probably not in any shape to be taking a Uber home.

 

[rmhaire]

Remind me to tell you about the time I was kicked out of ICU. It was on a friday the 13th about 30 or so years ago. My brother gave me a free viagra pill but no owners manual. After a heart attack and a stent, I woke up in ICU. After two hours or so they kicked me out. Said I was disturbing the sick folks in there. They moved me to a room but not before I came out of there with two phone numbers written on a slip of paper. To this day I have no idea who I was hitting on.

 

[somarco]

Remind me to tell you about the time I was kicked out of ICU. It was on a friday the 13th about 30 or so years ago. My brother gave me a free viagra pill but no owners manual. After a heart attack and a stent, I woke up in ICU. After two hours or so they kicked me out. Said I was disturbing the sick folks in there. They moved me to a room but not before I came out of there with two phone numbers written on a slip of paper. To this day I have no idea who I was hitting on.

I believe you just told me . . . and the entire world as well . . .

 

[rmhaire]

Good. Now you don't have to remind me. As far as the two phone numbers. Let me know if you want them and I'll send them on up. We can call them exclusive leads. Rest assured I never called them.

As far as your client, keep me posted. I'm tipping my hat to you on this one. Most agents would have bailed long before now.

 

[Todd King]

I have come across this before too, medcaid pays the premiums for the medsupp. not sure I see the real benefit of having a medsupp with medicaid though.
My understanding is that medicaid would act as the medsupp to medicare, negating the need for the medsupp. maybe I am missing something there?

I'm not sure what they call this level of Medicaid, but it's out there. They will pay for the Med Supp and (I think) may be on LIS too?

Either way, I've seen this quite a few times, but just can't recall exactly how it works with them.

 

[MBSC]

she is on OM + Medigap....She has gone past 90 days in the hospital and is eating away at her lifetime reserve. Hospital and her docs (on staff at NIH) informed her she is almost out of benefit. She has been in ICU almost 5 months . . .

Medigap plans cover an additional 365 days of inpatient care once the Part A lifetime reserve is exhausted. This should provide time to determine next steps.

From the Anthem BCBS of GA Outline of Coverage:

"Plan G:

Once lifetime reserve days are used:

Additional 365 days: Medicare pays $0, Plan pays 100% of Medicare eligible expenses, you pay $0.
NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid."