daily activities of living in hosp covered?

[vic120]

I just had a conversation with client, Really didn't understand all the specifics on the hows and whys and it did sound strange but ok here it is

What she is saying her husb is having a shoulder surgery , and because of his health issues with very low breathing comapsisty she said he is a high risk and if things go wrong he could end up in the hospital and need help with all the daily activities of living

I always understood this was not covered in a home health care situation but what about Hosp setting?

For other situations in the Future if they were in a nursing home I would like to know

 

[policywunk]

I just had a conversation with client, Really didn't understand all the specifics on the hows and whys and it did sound strange but ok here it is

What she is saying her husb is having a shoulder surgery , and because of his health issues with very low breathing comapsisty she said he is a high risk and if things go wrong he could end up in the hospital and need help with all the daily activities of living

I always understood this was not covered in a home health care situation but what about Hosp setting?

For other situations in the Future if they were in a nursing home I would like to know

Yes they get 3 hots and a cot and they just have to press the button and the nurse comes running. Sometimes seniors get marooned in a hospital because they can't go home an be themselves and there is no SNF bed available.

 

[somarco]

"Medical necessity" is always part of the equation when it comes to allowable charges that are eligible for reimbursement. This is especially true when it comes to inpatient services regardless of the type of facility.

Hospitals, rehab centers, SNF, etc are not day care facilities.

If "George" has a medical condition that requires inpatient care it should be a covered expense.

 

[vic120]

"Medical necessity" is always part of the equation when it comes to allowable charges that are eligible for reimbursement. This is especially true when it comes to inpatient services regardless of the type of facility.

Hospitals, rehab centers, SNF, etc are not day care facilities.

If "George" has a medical condition that requires inpatient care it should be a covered expense.

This makes a lot of sense

So SNF and rehab center would be the same if they are in those it would generally be medically necessary if not they would be sent home?

If so it wou9ld make sense I have never had an issue with custodial care not covered in one of those and the clients story does not make sense to me anyway

 

[somarco]

I won't be so bold as to claim that it has never happened with any of my clients, but I will offer a qualified "I don't recall that coming up, and if it did, the denial would warrant a deeper look and possibly steps to dispute the claim.".

ADL's don't require a licensed medical practitioner but those duties are normally carried out by orderlies and such in a hospital, SNF or rehab center.

 

[rmhaire]

I always understood this was not covered in a home health care situation but what about Hosp setting?

For other situations in the Future if they were in a nursing home I would like to know

All ADLs are covered while in the hospital. Doesn't matter if it's Obamacare or Medicare.

Same is true for SNFs, Rehab Centers and Nursing Homes. But by the time you get to the nursing home you're most likely going in on Medicare. The nursing home is going to lean on you to assign your benefits. (Don't do it)

And Hospice. Even better. Medicare pays 100% not 80. If you make it this far you can leave your supplement at home. You're not going to need it.