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...