Medicare Hoops and “Rules”
Everyone sees ads about how wonderful Medicare is. Here’s a story about hoops and rules that make patients seem like pawns in the hands of boards of directors.
Imagine you are in your 90’s on Medicare. You’re having rehab in a hospital after a heart attack, and next a back procedure is scheduled in the same hospital in 3 days. That sounds very do-able? Until.
The hospital informs you that you must check out in 2 days and then return for the procedure on the 3rd day (which is downstairs from your current room). So. Medicare has been petitioned to let you stay for additional rehab and the procedure.
Temperatures are in the single digits this week, and we all know that transporting patients of any age is risky. If you’re in your 90’s, it’s life threatening to go from room, ambulance, home, back to the hospital in a cold ambulance. It seems obvious to us, doesn’t it? The CEO’s of Humana and hospitals tick off boxes with no human connection to the patient. It’s more cost-efficient for the patient not to be transported twice.
For a family of an elderly patient to take time to appeal decisions from insurance companies and hospitals is unacceptable. Unless a patient has lawyers or savvy caretakers, nothing happens. Meanwhile you and your family wait and hope for the okay to stay in the room until the procedure. It’s the weekend in a snowstorm. Sunday evening is the anticipated move out day.
And there you are. Waiting.
I’m very sympathetic to this story although as Paul posted it’s hard to hit the like button. I will do so to let you know that I appreciate your sharing. As a 78 year old on Medicare myself, I learned early on to rely on the original when I had breast cancer and Sloan Kettering didn’t allow any of the so-called advantage plans (I believe they now have changed the policy somewhat). But I continue to muddle through with just the original. No horror stories yet . . .
I’d like to add that this indifference and bean counting is not restricted to Medicare coverage. It’s insurance companies across the board, along with Giant hospital conglomerates. An associate of my wife was admitted to an HCA facility in our area due to passing blood. Began on a Thursday.
On Friday, when she requested to be transferred to a larger hospital in our area, she was told that a particular specialist would have to determine the necessity for that. She never saw one. Her blood loss continued so she was put on an IV of isotonic saline. Slow drip. This was to be monitored and replaced when needed. No monitoring occurred. When empty, mid Friday afternoon, she called the nurses station. One nurse responded but said she had no standing orders for additional containers. Worse yet, the only doc who could have done so had left for the day! So she stayed and bled all week end.
Additional details aren’t the point. Her lack of adequate care and the lack of proper staff to provide care 24/7 shows our cash cow status upon entering a hospital like you have spoken of. And we have the highest cost for medical care in the world.