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Originally Posted by opinionist
My mother had traditional Medicare, but the system failed badly. She had dementia when she fell and broke her hip. She spent 3 days at the hospital before being transferred to a rehab facility, but she was not officially in the hospital for three days. Medicare refused to pay anything for rehab, and her secondary insurance refused to pay anything because of the decision by Medicare. If ever a patient needed a rehab facility, it was my mother. I was forced to pay out of pocket for a month of rehab, and that would not occur with Medicare Advantage.
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This was always an uphill battle with Medicare. For some reason the policy was a patient needed three days in the hospital prior to transfer to a skilled nursing facility for Medicare to pay. This was a catch 22 when there was no need for a patient to stay 3 days----without medical necessity they wouldn't pay the hospital and without 3 days inpatient they wouldn't pay the nursing home/rehab. It was always a conflict between utilization reviewers and discharge planners. Stupid rule IMHO since the inpatient days cost more than nursing home days.