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John Legal
John Legal, Attorney
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My mother has been in the hospital, rehab center for 1 month.

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My mother has been in the hospital, rehab center for 1 month. She fell down a month ago and broke her hip. After she had surgery to replace her hip and had a couple if days of rehab she was sent to a rehab facility to live. 2 days later she had a stroke, then she was sent back to the hospital for surgery to remove the blood clot. After a week in the hospital she was told she was healing well recovering from the stroke well and she would be released to my home. Then later that day she was told she could not go home because she had arrythimia (she has always had arrythima--never has cause a problem). 2 days later she was told she could go home, then that same day she was told she could not go home because she could not walk up steps. Then they put her back in the rehab center where they said she had an infection in the incision of her hip surgery. Now she is on very strong doses of antibiotics that constantly ill; vomiting, constant diarrihea. She has not been able to eat for a week and she is getting weaker and losing her ability to move and talk. The rehab center called me and asked to have the person who has the medical power of attorney to take over. My mother has a sound mind, she has told me what is happening to her. I have witnessed her deteriation. I want to remove her from the rehab center but have been informed that if we remover her from the rehab center then our insurance won't cover the bill. I need legal help to save my mother's life. I do not even know which doctor is in charge of her health care.
Welcome! Thank you for your question.

The facility is nearly certainly incorrect. Your mother, if she is mentally competent, or her appointed attorney in fact if she is not competent has the right to leave the facility regardless of whether the doctor or facility agrees to discharge. It is very rare that this would have an affect on Medicare paying for the services already provided.

Medicare covers a medically necessary inpatient rehab stay, as determined by the doctor who "admits" you to the hospital and by the rehab staff's continuing certification that it is necessary. Medicare, too, must agree that the stay is medically necessary. But the days of your stay would not retroactively become medically "unnecessary" just because you check yourself out before your doctor officially discharges you. If your stay in the rehab was appropriate in the first place, under Medicare rules, that stay should be covered regardless of the circumstances of your discharge.


There are a few circumstances in which a medical service might not be covered if a patient interrupts the care being provided. For example, if someone is undergoing physical testing or screening but leaves before it is completed, the office or clinic providing the care might bill the patient for the service but Medicare would refuse to pay its share of the bill. Or, if a patient is undergoing a treatment that must be completed in several stages but fails, without good reason, to complete the treatment, Medicare might refuse to pay its share of the bill. Unless some similar circumstance occurred regarding your stay, Medicare would have covered your inpatient care regardless of whether you waited for your doctor to discharge you.

Here is a link to the long term care ombudsmen program for the state of Michigan. They provide free patient advocacy and will assure that your mother is heard and given her proper rights with regard to treatment. Contact your local ombudsmen and get them involved.

http://www.michigan.gov/osa/1,4635,7-234-43230_46224---,00.html


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Customer: replied 3 years ago.

Dear XXXXX:


If we take her out, and it turns out down the road, that she needs to be readmitted to the hospital or rehab center for a medically necessary reason, can they Medicare or her insurance refuse to pay for this future visit. Or can the staff refuse to treat her , etc... Isn't there something wrong with the fact that we don't know who is in charge of her case. My father visits her at the rehab center every day.

No not at all. Her removal has nothing to do with payment. If the needs help she will receive it and it will be paid for. She has a legal right to direct her care, right or wrong.

I would be very hesitant to take her to the same facility. It is possible that they refuse to readmit her. If it is your local regional hospital they cannot refuse treatment. The rehab facility can.

The person overseeing her care should be the physician at the facility and her nurse in charge of her section. You should demand to have a hierarchy chain.
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