Did you know … that if you live in Texas and 9 other pilot project states Medicare may not admit you to rehabilitation after a hospital stay, EVEN THOUGH YOU ARE qualified because the new protocols published by the Obama Administration are resulting in “medical necessity” denials even when the patient needs the care?
This type of program, where nearly all “applicants” are denied is not new to the government. The social security administration has processes in place to deny nearly all new applications for disability coverage. It is considered a test of sincerity. The policy discourages enough people who are entitled to the benefits that the practice pays off for the fund. Of course, people suffer who should not suffer and lawyers make money when they really wouldn’t need to if the program were administered honestly.
In the case of a senior on Medicare, almost any 3-day admission to a hospital will result in a legal finding that rehabilitative services are medically necessary. This will give the patient access to up to 100 total days of physical therapy and other rehabilitative services delivered in an SNF or specialized rehab center. The program was developed to combat the rate of bounce back to hospitals from seniors sent home too early. But, if you are a Texan, right now, the hospitals are sending you home, without rehab, due to a lack of “medical necessity.” Of course, you can appeal, but it must be done instantly, and it must be in writing.
Understanding your benefits under Medicare is crucial in making sure that you get all the coverage you are entitled to.