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Question about nursing homes and insurance coverage. Any social workers?

My father since Feb. has been a dialysis patient and since late March has Medicare. He has Aetna insurance. Aetna is primary now, Medicare wont be until 18 months I believe. On the 23 of July he had a fem pop bypass (on leg). And his kidney doctor, not the surgeon, requested he stay some where for rehab. In our city there was I guess only two choices a nursing home or a rehab unit of a local hospital. Well while in the hospital we found out the nursing home only covered his insurance, so he has been their 10 days. Well now I received a call today that the admissions people want to talk to us because now they found out Aetna only covers if he has three therapies. He is having two OT and PT. And actually they had to stop PT because every day he would bleed from one of the wounds. We visited the surgeon yesterday to looked at the area that was still bleeding and he said they should of never had you walking, it was too soon so he had to put staples to close the wound. And the nurse practitioner of the doctor said really she believes they wanted to rush therapy because every visit to the PT unit at the home is being charged. Any ways the lady couldnt tell me much on the phone but said to come in, and she sort of sounded like for us to try to find a way to pay out of pocket for the days. Whose at fault, shouldnt of they look in the coverage before or at least a day or two after he was brought in? Well I hope no one ever goes through this. A few times my dad leg would bleed and soak the dressing. We would tell the nurse if she could change it and they would do it hours later. Thanks!

   








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My father since Feb. has been a dialysis patient and since late March has Medicare. He has Aetna insurance. Aetna is primary now, Medicare wont be until 18 months I believe. On the 23 of July he had a fem pop bypass (on leg). And his kidney doctor, not the surgeon, requested he stay some where for rehab. In our city there was I guess only two choices a nursing home or a rehab unit of a local hospital. Well while in the hospital we found out the nursing home only covered his insurance, so he has been their 10 days. Well now I received a call today that the admissions people want to talk to us because now they found out Aetna only covers if he has three therapies. He is having two OT and PT. And actually they had to stop PT because every day he would bleed from one of the wounds. We visited the surgeon yesterday to looked at the area that was still bleeding and he said they should of never had you walking, it was too soon so he had to put staples to close the wound. And the nurse practitioner of the doctor said really she believes they wanted to rush therapy because every visit to the PT unit at the home is being charged. Any ways the lady couldnt tell me much on the phone but said to come in, and she sort of sounded like for us to try to find a way to pay out of pocket for the days. Whose at fault, shouldnt of they look in the coverage before or at least a day or two after he was brought in? Well I hope no one ever goes through this. A few times my dad leg would bleed and soak the dressing. We would tell the nurse if she could change it and they would do it hours later. Thanks!


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My father since Feb. has been a dialysis patient and since late March has Medicare. He has Aetna insurance. Aetna is primary now, Medicare wont be until 18 months I believe. On the 23 of July he had a fem pop bypass (on leg). And his kidney doctor, not the surgeon, requested he stay some where for rehab. In our city there was I guess only two choices a nursing home or a rehab unit of a local hospital. Well while in the hospital we found out the nursing home only covered his insurance, so he has been their 10 days. Well now I received a call today that the admissions people want to talk to us because now they found out Aetna only covers if he has three therapies. He is having two OT and PT. And actually they had to stop PT because every day he would bleed from one of the wounds. We visited the surgeon yesterday to looked at the area that was still bleeding and he said they should of never had you walking, it was too soon so he had to put staples to close the wound. And the nurse practitioner of the doctor said really she believes they wanted to rush therapy because every visit to the PT unit at the home is being charged. Any ways the lady couldnt tell me much on the phone but said to come in, and she sort of sounded like for us to try to find a way to pay out of pocket for the days. Whose at fault, shouldnt of they look in the coverage before or at least a day or two after he was brought in? Well I hope no one ever goes through this. A few times my dad leg would bleed and soak the dressing. We would tell the nurse if she could change it and they would do it hours later. Thanks!


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Question about nursing homes and insurance coverage. Any social workers?
My father since Feb. has been a dialysis patient and since late March has Medicare. He has Aetna insurance. Aetna is primary now, Medicare wont be until 18 months I believe. On the 23 of July he had a fem pop bypass (on leg). And his kidney doctor, not the surgeon, requested he stay some where for rehab. In our city there was I guess only two choices a nursing home or a rehab unit of a local hospital. Well while in the hospital we found out the nursing home only covered his insurance, so he has been their 10 days. Well now I received a call today that the admissions people want to talk to us because now they found out Aetna only covers if he has three therapies. He is having two OT and PT. And actually they had to stop PT because every day he would bleed from one of the wounds. We visited the surgeon yesterday to looked at the area that was still bleeding and he said they should of never had you walking, it was too soon so he had to put staples to close the wound. And the nurse practitioner of the doctor said really she believes they wanted to rush therapy because every visit to the PT unit at the home is being charged. Any ways the lady couldnt tell me much on the phone but said to come in, and she sort of sounded like for us to try to find a way to pay out of pocket for the days. Whose at fault, shouldnt of they look in the coverage before or at least a day or two after he was brought in? Well I hope no one ever goes through this. A few times my dad leg would bleed and soak the dressing. We would tell the nurse if she could change it and they would do it hours later. Thanks!