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Sunday, January 26, 2014

And I Spoke Too Soon!

Just when I thought everything was going easy-peasy with PT (see last post), the therapist in charge of "recertifications" showed up on Friday and discharged Bob! GAA! Just like that.

Of course, I was floored. And asked why. And she told me it was because the insurance did not approve his therapy and that they (the home health agency) had not been paid for any of the visits in January.

Well, this didn't seem right to me and I thought I'd gotten an approval letter in the mail. So I dug the letter up and found, oops, I didn't thoroughly read it, because it was only approval for nursing visits, not for PT. But the strange thing about the letter was the doctor's name was wrong, it was not the GI doctor's name, but the neurologist who orders PT... so I figured something is really screwed up here.

I told the therapist this, and I also told her I would call the insurance company to find out what's going on, then she tells me not to bother because Bob has not "progressed" enough and he's "been in the system too long" and it's time end therapy.

Of course, this threw me for another loop. And of course I argued. Then she told that me that Home Health Care Agencies do not provide long term "maintenance" for patients, and if I wanted that, I should put Bob in a nursing home! AARGH! So, I brought up the fact that the Medicare guidelines have changed to allow continuous PT for "maintenance" and the "progress" no longer necessary -- and she did not believe me. So I had to get on my computer and prove it to her. And I even printed out a copy of the article that I found.

Then, she told me that, really, I should take him to Outpatient Therapy instead, but I told her I didn't think Bob was strong enough to endure the rigors of Outpatient Therapy yet.

And, so, we went back and forth.

But it all came down to the insurance company hasn't paid a dime this year. So, Bob's been discharged. Poor Bob was listening to all this, lying in his hospital bed, saying "Exercise? Exercise? Please?" and I felt really terrible for him.

Of course, after she left, I immediately call the insurance company and, after being transferred around, and put on hold forever, and cut off once (grrrr) so I had to call back and start all over -- I finally find that the insurance company has no record of a script for either the nursing visits or PT for this year. When I tell them about the letter I received, dated January 4, with the wrong doctor's name on it, they tell me they have no record of that at all..... hmmm?

So I call the Home Health Agency, and after talking with a supervisor there for a good long time (because she can't figure out what's going on, either), she finally tells me she's going to talk to the insurance department and get back to me...

Which she does. And it turns out, they did send scripts in December, but because they were dated "December", they did not apply to the new year. So they have to send new authorizations through, dated in January, which she's going to do.

So no PT until this cleared up. If this gets cleared up. And IF the therapist in charge of certification will agree to it.

Meanwhile,  I am once again drowning in legal papers and The Green Machine has taken another dump so I am, again, without a car.

Just another day in paradise...


Theresa Loder said...

Hi Diane
The exact same thing happened to us..after having conversations with and filling out forms and getting a letter from the doctor, the home care company at their meeting decided to end Ricks PT because they said he didn't need this point..
its like we were talking to a wall..good for you for going on line and coping that new law..

For us then the home care called back a week later and wanted to come over and reevaluate him...they also couldn't find any paper work from the doctor even though I gave them a copy..

Rick pretty much told them he would never use that company again...

I know with Bob you must have the therapy..

Rick has a doctors appointment Tuesday if his legs will work right...

And all his bills were paid by insurance company to the home health...

On a good note
We won our appeal to medicare for them to pay the $700 to Pasco Fire Rescue when Rick had to call 911 last September...
I followed the instructions to the letter...

Thinking of you guys...sorry about the Green Machine again..

Prayers for you both...
take care

J.L. Murphey said...

I always make a point of getting new scripts for everything each new year even if there is an over flow of time leftover from the previous year. It's just me being anal again but it has saved my butt many times. T's pulmonologist used to write 99 refills at the beginning of each new year. Not that T would ever need that many, but it covers the whole calendar year.

I usually make the rounds of all the ologists in January anyhow. Needless to say, I usually hit my maximum yearly out of pocket expenses by February. Pretty sad when you think about it.

New year a new/old set of problems. I'm right there with you. Praying for you both.

Jenn said...

Two steps forward one step back
Cha cha cha
Two forward one back
That's it, now you're getting the hang of it!
Forward back forward back
Good, cha cha cha, yes!
Now let me just get this rug out of tthe way
Oops! So sorry
Cha cha cha.

Stoopid dance instructor.