EliseoRNCCM
New Member
- 10
Your cousin has to tell the case manager that he would like to appeal the discharge.[EXTERNAL LINK] - Determinations, Grievances, and Appeals - Your South Florida Medicare Provider - HealthSun Health Plans
Next time you call Health Sun, have him on the phone with you so he can tell them it's ok to speak with you.
The case manager will let their Utilization case manager know. UM RN will start the process and will speak with your cousin.
Your cousin can also call the Medicare 800 number to file. Medicare will call the MA and the UM. All together they will notify your cousin if the extended hospital stay will be covered or not. If denied, then your cousin has 24 hours before he is charged the HOSPITAL daily rate which can be $4500+ per day.
If you're going to be by your cousin's side, ask the case manager for an advance directive form to fill out so that you can be the designated POA if and when he is not able to speak. Do that now for future issues so that you, your cousin and the hospital staff won't have to guess what your cousin's wishes are.
I know you're scared of all the "what ifs" but if he can safely go to your house and create a plan then that would be a safer route than a rehab. Have the home care services go to your house if it is covered. If not covered, RN PT OT visits are about $300/ visit.