I appreciate this explanation of the law. It can become difficult if a patient has additional needs for Subacute rehabs as there must be a 60-day break between rehab admissions to reset the 100-day clock, thus to run the time to the max may be a barrier for a subsequent need for rehab. It is depends on the situation.
Hello! My mother is in skilled nursing right now. We just got her discharge notice she is supposed to be discharged Saturday August 18, 2023. The 20th day was yesterday. I called the number on the discharge notice and started the first appeal just now. I tried calling your office to see if you could help us, but they said you don’t handle these. we are in California is it necessary to have a California bar attorney or is it possible that you or someone else can help us with this in any state?
We do not practice in California, but you could contact the Life Care Planning Law Firms Association and look at their attorney directory. www.lcplfa.org/ Thank you for reaching out.
We appealed twice and were denied for my mom's continued stay in a skilled nursing facility. We are scheduled for an ALJ hearing this coming week. Thankfully, we were able to private pay for the remainder of the month her coverage was terminated. We were able to get my mom back on Original Medicare the first of the following month after disenrolling from her advantage plan. We learned our lesson to never enroll in an advantage plan ever again. They deny care not based on Medicare coverage rules, but on algorithms and internal coverage criteria. Also, a skilled nursing facility resident qualifies for a special enrollment period where they can switch back to Original Medicare while they are a resident and for 2 months after leaving a skilled nursing facility.
I appreciate this explanation of the law. It can become difficult if a patient has additional needs for Subacute rehabs as there must be a 60-day break between rehab admissions to reset the 100-day clock, thus to run the time to the max may be a barrier for a subsequent need for rehab. It is depends on the situation.
Very good explanation. I am seeing this more often lately.
Hello! My mother is in skilled nursing right now. We just got her discharge notice she is supposed to be discharged Saturday August 18, 2023. The 20th day was yesterday. I called the number on the discharge notice and started the first appeal just now.
I tried calling your office to see if you could help us, but they said you don’t handle these. we are in California is it necessary to have a California bar attorney or is it possible that you or someone else can help us with this in any state?
We do not practice in California, but you could contact the Life Care Planning Law Firms Association and look at their attorney directory. www.lcplfa.org/ Thank you for reaching out.
What about Advanatge plans. Is it the same rules?😊
Here's some info about Medicare Advantage plans: th-cam.com/video/Q7XWV2dx-Zo/w-d-xo.htmlsi=pCykWzEE3Hfi3i0a
We appealed she got denied
We appealed twice and were denied for my mom's continued stay in a skilled nursing facility. We are scheduled for an ALJ hearing this coming week. Thankfully, we were able to private pay for the remainder of the month her coverage was terminated. We were able to get my mom back on Original Medicare the first of the following month after disenrolling from her advantage plan. We learned our lesson to never enroll in an advantage plan ever again. They deny care not based on Medicare coverage rules, but on algorithms and internal coverage criteria.
Also, a skilled nursing facility resident qualifies for a special enrollment period where they can switch back to Original Medicare while they are a resident and for 2 months after leaving a skilled nursing facility.