People are purchasing long term health care coverage and then get denied the help they need. Please advise if you or loved ones have experienced this problem
REQUEST FOR INFORMATION FROM SENIORS OR FAMILY MEMBERS WHO THOUGHT THEY HAD LONG TERM COVERAGE AND HAVE BEEN KICKED OUT OF REHAB OR NURSING HOMES
It's a big problem for the elderly and for family members who leave rehab facilities crying because they can't get help
In recent months I have learned of incidents that have been heart breaking. Senior citizens and their families have told me that they thought they had long term coverage, the senior went to rehab after being hospitalized and then was prematurely kicked out because the nursing home, rehab said that the insurance wouldn't reimburse them. The patient thought they had coverage but after two weeks or so they would be kicked out. I I would like to reach out to state lawmakers and ask them to investigate this situation.
Your help is needed. If you have experienced this problem or know of people who have had similar problems please e mail me or drop me a note with a summary of your experience. If you were able to successfully appeal a denial of care please advise. I will share with state lawmakers. My e mail is pfeiner@greenburghny.com
I recently interviewed Adria Gross on my WVOX radio program. She highlighted the problem. If you know of other advocates who have been working on this issue please also advise.
- Adria Gross, an advocate for people who have had problems with nursing homes/rehab facilities for many years, was a recent guest on Supervisor Feiner’s weekly Greenburgh Report radio show on WVOX. You can listen to the interview on YouTube here: https://youtu.be/DtoRsY-YqVs
“Medicare Advantage plans are really awful when someone ends up in a rehab,” she said. “I’m just shocked with what goes on with these Advantage plans.”
Coverage getting denied after getting into a rehab/nursing facility is a common problem. Medicare is a government program that relies on commercial insurers and the commercial insurers have control over the nursing home/rehab process. They can tell the facility they are not going to pay to keep a patient in, which often leads to a patient being told they have to leave a rehab prematurely after a hospital stay – before they are ready or able to return home. For some, support at home should also be covered, but they might find themselves being denied as well.
HOW TO FIGHT: They are going to request medical records, so you have to get letters from your providers (doctors) indicating why you were unable to go home or why you need additional support at home. Gross states that “very often this ends up going before a judge.” She continues, “I tell people, ‘don’t pay, don’t pay, don’t pay’ when the big medical bills come for getting the care you need. Gross has typically been successful getting cases overturned and money paid back.
Listen to the interview: https://youtu.be/DtoRsY-YqVs And, e mail me your experiences at pfeiner@greenburghny.com
PAUL FEINER
Greenburgh town Supervisor