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Glad to report that husband was transferred to a rehab last evening.
Did I say it is VITAL to read this link?
^^^
I have had an experience with this Medicare rabbit hole recently -- still half way in as a matter of fact 
Whoa, mtierney, thanks for posting! What a mess! I hope you are managing to make your way out of the hole.
Very difficult. As the article states, you can appeal; but, if your experience is like mine, you are likely in no condition to do so on your own and time pressures don't make things any easier. The facility where he is currently being treated will likely have a social worker on staff who can help you work through this morass; but, it is best to have a friend, relative or outside professional help you with this.
It is so important to read the Medicare and You book that you should receive in the mail every year. One of the things they never tell you until you are faced with it is that Part A coverage for hospital and rehab facility care is not unlimited. From page 34 of this year's book (2017):
You pay a deductible and no coinsurance for days 1 - 60 of each benefit period.
You pay co-insurance for days 61 - 90 of each benefit period.
You pay coinsurance per lifetime reserve day after day 90 of each benefit period (up to 60 days over your lifetime.
You pay all costs for each day after you use all the lifetime reserve days.
A benefit period is defined on page 121 as beginning the day [the patient is] admitted as an inpatient in a hospital or [skilled nursing facility]. The benefit period ends when [the patient hasn't] received any inpatient hospital care (or skilled care in a [skilled nursing facility]) for 60 days in a row...
Bernie was hospitalized for over 90 days with a period of maybe a day or two between hospitalizations. This is how I learned about this Medicare provision.
it has been a long day in hospital and rehab, maybe tomorrow I'll understand this paragraph, but can anyone put in direct unambiguous language?
"benefit period is defined on page 121 as beginning the day [the patient is] admitted as an inpatient in a hospital or [skilled nursing facility]. The benefit period ends when [the patient hasn't] received any inpatient hospital care (or skilled care in a [skilled nursing facility]) for 60 days in a row..."
TIA
This is a direct quote from the book Medicare and You which you should have received in the mail. In plain English this means that a patient's Medicare coverage for a given hospitalization begins on the day they are admitted to the inpatient facility. If the patient comes home for a period(s) of less than 60 consecutive days prior to readmission, it all counts as part of the same hospitalization (benefit) period. For example: If a patient is hospitalized for 20 days, comes home and is readmitted five days later, it counts as one benefit period not two.
Probably most people reading this thread are aware of this, but I thought I'd mention it anyway: A person can be in an ER for a day or perhaps longer, but NOT YET ADMITTED to the hospital as an in-patient and this has ramifications for insurance coverage, by Medicare and others. I read something recently about this; I don't want to post just from my memory in case my recall is faulty, but it is something you could google if you think it might apply to a particular case. The article did mention that family members should specifically ask the status of a patient in an ER to be clear about insurance issues.
I am reposting this article on Medicare's latest revised corrections to prior policies. Until the minions in the health care system get the memo, the consumers need to educate themselves.
cody said:
Probably most people reading this thread are aware of this, but I thought I'd mention it anyway: A person can be in an ER for a day or perhaps longer, but NOT YET ADMITTED to the hospital as an in-patient and this has ramifications for insurance coverage, by Medicare and others. I read something recently about this; I don't want to post just from my memory in case my recall is faulty, but it is something you could google if you think it might apply to a particular case. The article did mention that family members should specifically ask the status of a patient in an ER to be clear about insurance issues.
We had this very outrage perpetrated on us on May.
Husband was rushed from doc's office to ER with renal failure on a Tuesday afternoon. He was brought up to a hospital bed in the ICU for multiple tests etc.
Throughout the next day, Wednesday, he received many tests and procedures.
On Thursday morning, he was still receiving intense medical attention by a number of specialists.
Around noontime Thursday. A parade of social workers and others arrived in the room to announce he was being discharged!!
He had been given a catheter, could not stand or walk, but had to be released because his status was "observation" and not "admitted" into the hospital.
Because of this fact, Medicare would not pay. Medicare would not pay for a rehab either!
I rejected the offer that they would "find" a bed in a rehab somewhere. I wanted the time to check out a place close to our home and one I felt was acceptable. They would not allow him to stay a third night, so I had him transported to our totally unprepared home.
It was just him and me that Thursday night - the hospital did hand me a commode on the way out however. An item he had no capability of utilizing.
And so the journey down the Medicare rabbit hole began.
mtierney said:
cody said:
Probably most people reading this thread are aware of this, but I thought I'd mention it anyway: A person can be in an ER for a day or perhaps longer, but NOT YET ADMITTED to the hospital as an in-patient and this has ramifications for insurance coverage, by Medicare and others. I read something recently about this; I don't want to post just from my memory in case my recall is faulty, but it is something you could google if you think it might apply to a particular case. The article did mention that family members should specifically ask the status of a patient in an ER to be clear about insurance issues.
We had this very outrage perpetrated on us on May.
Husband was rushed from doc's office to ER with renal failure on a Tuesday afternoon. He was brought up to a hospital bed in the ICU for multiple tests etc.
Throughout the next day, Wednesday, he received many tests and procedures.
On Thursday morning, he was still receiving intense medical attention by a number of specialists.
Around noontime Thursday. A parade of social workers and others arrived in the room to announce he was being discharged!!
He had been given a catheter, could not stand or walk, but had to be released because his status was "observation" and not "admitted" into the hospital.
Because of this fact, Medicare would not pay. Medicare would not pay for a rehab either!
I rejected the offer that they would "find" a bed in a rehab somewhere. I wanted the time to check out a place close to our home and one I felt was acceptable. They would not allow him to stay a third night, so I had him transported to our totally unprepared home.
It was just him and me that Thursday night - the hospital did hand me a commode on the way out however. An item he had no capability of utilizing.
And so the journey down the Medicare rabbit hole began.
ML, Did your Medicare Supplement (or Advantage coverage) help offset any of the expenses that Medicare denied?
No. Another lesson learned: if Medicare doesn't cover 80% of medical costs; our Medicare supplemental (AARP) plan, which would have covered 20%, pays NOTHING.
Supplemental insurance does not kick in if Medicare denied coverage. 
Meridian Hackensak in 0cean County has a visiting nurse program and there is a service, Better at Home, which has a doctor who comes to your home. Various tests are available such as X-ray, EKG,blood work and OC&PT home services.
Hope - and pray -- Congress doesn't screw this proposed legislation.
it's all about planning..
Not just for seasoned citizens -- or those "burdened" with great wealth.
I realized today that I have been ignoring this thread but piggybacking my questions on other senior threads 
Does anyone have a link to a men's clothing outlet which provides easy on easy off trousers-- with an elastic waist?
it's been awhile since I posted here -- I have been coping with the role of caretaker and all that the word entails. Husband is cooperative and accepting of our new lifestyle so that is what keeps me going.
But here is my current angst: our phones (5) ring all day from 8 am to 9 pm with robocalls! Efforts to ban them seem to encourage others to chime in.
I was about to get rid of the extensions to cut down the noise and deal with one device; I also wonder about cutting the landline altogether, but don't know about alerting those people and places which have our number.
Comcast has a "nomorobo" option -- something new that prevents such calls. Anyone try that?
He is a high risk for falls and we have a medical alert system, so we can't do anything to jeopardize this.
TIA
While not an easy solution, gather the phone numbers that are important, relatives, friends and med. providers. Then change the phone number. Notify the friends and relatives by email.,
I have a question that's probably a dumb one. It looks like we're getting close to the point where we'll have to move my 90-year-old father into a care facility--he currently has home health aides, but his dementia is getting worse, which makes it harder for them to help him. We're new to this whole idea and aren't really sure where to start. So my question: is there such a thing as a social worker or other professional who helps with this process but isn't affiliated with a specific institution?
And if anyone has recommendations for a care home in or near the city, please send them my way. Thanks.
Begin by contacting the social worker in your or his community.
In our area, the Chelsea chain is the best of the three I had my mother in. Chelsea in Belvedere is the least expensive of that group. The home in North Plainfield ( I will look up the name later if you want) was the least expensive but the care was primarily physical... food, bathing and so forth.
Consider also visiting an Elder Law attorney. You can get referrals from the county Bar Association. Make a list of his assets and another list of your concerns to bring to the consultation with the attorney.
Was he a veteran? Are there significant assets to protect? What is his disposition? Is he likely to physically act out? Is he able to interact with people or is he withdrawn into himself.
Tell me a bit more an I will try to offer more specific information.
Thanks, jerseyjack. How do we go about finding the social worker in his area (he's on the Upper West Side)?
He is a veteran (barely). His assets are limited, since he rents. He has a bit of money in investments and some money in the bank, though that's been eaten into by the cost of home care, which he's had for a couple of years. He's sometimes argumentative and can be stubborn, but he's never been physically aggressive in the least. He has limited mobility and uses a wheelchair or a walker most of the time, and he needs help with dressing, showering, etc. He goes through periods of lucidity and full awareness, but gets confused at other times, particularly if he hasn't slept well. He's also hard of hearing, which doesn't help with communication. He's prone to withdrawing into himself, but he's pretty gregarious when there are people around and usually enjoys company.
That's about all I can think of. Thanks again for any help you can offer.
How about a consult: https://newoldage.blogs.nytimes.com/2008/10/06/why-hire-a-geriatric-care-manager/
It's such a difficult position you're in, whether nearby or at a distance. Best wishes to you & your dad!
eta: I have no personal experience with a "manager," as we were 3000 miles from parents & brother-in-law devotedly handled everything. but sounds good.
And re: your question about finding a social worker. I think most cities have a Dept of Aging that could direct you. Does NYC have a 211 line for questions about social services??
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I'm just posting because someone someone couldn't find this thread....