insurance questions

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Specializes in Tele, Cardiac Post Op, ER.

What usually happens when patients have run out of insurance coverage (medicare/medicaid or private) and need to stay in the hospital for longer? Where do they go? Are they kicked out of the hospital? Or do they stay at the same hospital and filed as a charity case? My aunt's mother had this happen and she went to a different SNF facility, where they could cover some.

How is this usually handled?

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Specializes in Tele, Cardiac Post Op, ER.

so are they sent to a county hospital or something?

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The pt is not "kicked out". This is something the family may feel to be true but, until they are no longer acutely ill they stay in the hospital. Medicaid does not run out, at least where I live. The pt gives up their social security check and the state pays for the rest. They must meet medicaid eligibility requirements which basically means they have no more than $2000.00 in assets. They must also be considered physically dependent or mentally dependent ( advanced dementia).

Medicare pays for 20 days of skilled care at 100% as long as the pt requires skilled care. This means a RN, PT, (OT and ST). After the 20 days medicare will pay 80% and secondary insurance pays the other 20% providing the pt requires skilled personnel.

Private insurance is a creature of it's own. They will pay for a few days meaning as few as possible. Forget inpatient rehab if your private insurance. THey will pay for CVA, bilateral joint replacement, trauma pts. etc, etc... You must have a true rehab diagnosis. Then they may still try to get out of paying for your care.

I live it everyday in the hospital. The insurance company holds the reins. If you ever need them to pay ,the premium payer ,should give them hell.

Get what you pay for with the insurance com. Hope this helps.:specs:

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Specializes in med/surg, telemetry, IV therapy, mgmt.

the facility has their social worker handle this. if the patient has no home to go to the social worker will apply for medicaid benefits on behalf of the patient. it is illegal to just turn the patient out on the street if they have no where to go.

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