How long will MA pay for continous stay in hospital.?

[somarco]

@Millwood that's a bummer. There are no good or easy answers.

 

[rmhaire]

FIRST thanks to all who gave me insight. It's all fun and games till it's family. This....... had a long talk with Doctor.
On what to expect.

First, I'm sorry to hear about your sister in law. I'll be praying for her, you and the family.

Second, You're exactly right about the fun and games part. I've been a full time caregiver for my wife the last 15 years. Alzheimer's. And she's been on Hospice the last 10. So I've got a pretty good idea how all this stuff works.

Third, You raised a very good question for all of us to consider. Thanks for bringing it up.

 

[Yvette]

United Healthcare explicitly states UNLIMITED number of days in a hospital if medically necessary. They go way beyond Medicare alone.

 

[rmhaire]

United Healthcare explicitly states UNLIMITED number of days in a hospital if medically necessary. They go way beyond Medicare alone.

We were beginning to think you'd never get here.

We beat the hell out of this one last week. The words you need to concentrate on are If Medically Necessary. That's the key. And no company, including UHC, goes way beyond Medicare alone. That's simply not how this stuff works.

 

[somarco]

According to UHC each hospital admittance is a new benefit period.

What about readmission's?

OM has a policy about readmission vs "new" admission.


Readmission – an admission to a hospital occurring within 30 days of the date of discharge from the same hospital or a related hospital.

Do MA plans have similar verbiage?



And yeah . . . ALL health insurance policies apply the "medically necessary" rule. So what else is new?

 

[StephanieCJ]

"if medically necessary" means as long as the doctors/hospital can provide documentation showing necessity. Some people are acting like this is a new concept. Medicare=90 days plus the lifetime reserve whether or not there is medical necessity. Unlimited means just that, so long as their is medical necessity. No plan, OM or otherwise, will pay for you to live at the hospital for the rest of your life without reason.

To answer with readmission vs. new admission, that is going to be company specific and found in the Evidence of Coverage. I have seen companies that start the copays over for readmissions and I've seen companies that will only start it over if there is a 60-day break.

There are no blanket answers that can be applied to questions like this concerning MA plans because they each function differently within the guidelines set out by CMS. Find the specific plan, reference the EOC and you have your answer.

 

[somarco]

Medicare=90 days plus the lifetime reserve whether or not there is medical necessity.

Where did you find this tidbit?

 

[rmhaire]

No plan, OM or otherwise, will pay for you to live at the hospital for the rest of your life without reason.

Probably the best answer yet. But I still haven't seen anyone post about how this stuff really works.

I know a lady that was diagnosed with Alzheimer's at age 55. She'll be 72 in December.

She's currently on Hospice. When she went on Hospice, Medicare required an assessment every 60 days. These assessments are required to show a definite decline in the patient's health. If the patient can not show a decline they are removed from Hospice.

The assessment process is pretty much universal. It applies to Hospice, the Hospital, Nursing Homes and all the others. It's Medicare that does this not the provider.

Anyway, last month this lady was assessed three times by different Drs, PAs and Nurses. Three different assessments in one month. Why? Because Medicare is trying to kick her off. Why? Because she's been on Hospice for over 10 years.

You don't see this kind of stuff in a company brochure or website. This is how Medicare does "If Medically Necessary."

 

[StephanieCJ]

Where did you find this tidbit?

I worded that wrong. Don't tell my husband that I'm not perfect. I meant to say no more than 90+the lifetime reserves even with medical necessity.

 

[somarco]

I worded that wrong. Don't tell my husband that I'm not perfect. I meant to say no more than 90+the lifetime reserves even with medical necessity.

Still looks wrong to me.

Even before the 90 day mark, they will not be allowed to stay in the hospital unless there is a medical reason to keep them there.

SOMETIMES they will delay discharging to their home if no one is there to assist them, but if that happens they will be discharged as soon as they have someone to help with ADL in the home . . .

They delayed discharging my wife a few years ago because the DME that was prescribed would not be available until the next day.

I have your hubby on speed dial but promise not to tell if you send me a bottle of wine. Pinot or Merlot is preferable.