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My grandmother had her TAVR and unplanned pacemaker insertion on June 9. She was discharged from the hospital late in the day on June 10. Was doing OK at home until she developed 101.7° temperature four days postop on a Friday evening. We tried to reach her cardiologist and got no reply from the answering service. The home health PT happened to be at the house and she recommended I take her to the hospital. The home health RN on call was also contacted and she recommended the same. I took her to the hospital an hour away that did the procedure, and after 18 hours in the ER, they kept her and she was released late in the day on Monday, June 15. We arrived in the ER around 9 PM Friday evening. Also of note is when she was put back in the hospital, they realize that she should’ve been sent home from the initial procedures with oral antibiotics. She was not. So they made a mistake. The hospital has assigned this as being on observation status, so of course her Medicare advantage plan is not wanting to pay. We plan to fight this. None of the medical professionals we consulted recommended that we’d stayed at home. When she got admitted, they did blood cultures, urine cultures, a chest, x-ray, a CTA scan, and Doppler studies of her very painful left arm, which is the same side as the pacemaker. Saturday afternoon, the cardiology team NP came by and said she was definitely being admitted, because they wanted to await the results of the blood cultures and also do an echo. And of course, adding to the mystery is that her temperature was normal by the time I got her to the hospital, stayed normal during her stay,, and reappeared after she returned home from the re admission. So she is still now being evaluated outpatient with another echo and bloodwork this week.
So her rejection letter from Medicare states that she did not need to be admitted because she did not have an infection. Well, we were awaiting the results of the blood cultures to find out if she had an infection. Anyway, I’m in the process of researching how to appeal this. Apparently, she was also in the hospital for two midnights so that alone should qualify her for payment for a Medicare. Does anyone have any words of wisdom on how to do all this?

Agree with the points Geaton mentioned. It’s not the end result that matters so much but the concerns and data on presentation. Also mention any abnormal vital signs, like fast heart rate or fever. Also any IV medication the patient needed or if she needed supplemental oxygen (not her baseline) or how many consultants were involved in her care, possibly cardiologist and infectious disease, thoracic or CV? Did she have daily laboratory draws? Was she not acting like herself, confused or weaker than normal, below her functional baseline? Physical therapy evaluation? Did she have any abnormal lab results? Elevated wbc, inflammation markers like CRP or lactic acid? or kidney function problems? Get the data, request an appeal if a peer to peer with the treatment physician is unsuccessful. Ask for case management to assist you.
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Reply to Beethoven13
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Updating to say that we called the hospital billing department today. They were aware of the rejection and are working on it. I also pointed out in the wording of the denial letter that basically it just says they’re not going to pay because she ended up not having an infection. I pointed out that it was as if they did not read her entire medical record, to include the fact that she recently had the two surgeries. They said they had already been notified of the rejection and will work on it. We will be checking back in a month or so.
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Reply to Oedgar23
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If she has Medicare Advantage why would Medicare itself be involved? The whole purpose of Medicare Advantage is everything is under one umbrella. They are contracted out by Medicare to handle A and B. All claims go thru them is what I understand. Nothing goes thru Medicare themselves. Does Mom have an actual Medicare card?

"No, you cannot have both Traditional (Original) Medicare and a Medicare Advantage Plan simultaneously. [1]
To join a Medicare Advantage Plan (Part C), you are required to have both Part A and Part B. However, when you enroll in a Medicare Advantage Plan, the private company providing the plan assumes the management and payment of your Medicare Part A and Part B benefits. You are still technically enrolled in Medicare, but your coverage and claims are governed by the Advantage plan rather than Traditional Medicare."
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Reply to JoAnn29
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Remember that most Medicare advantage plans pay after first rejecting. Stay calm yet persistent and confident that you did the right thing. Also the hospital should be willing to help you deal with the insurance.

GM is lucky to have you.
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Reply to 97yroldmom
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I had a similar issue when I was admitted the second time for a bowel blockage (long story). I ended up only being inpatient for two nights, which was great until our insurance rejected the admission. The hospital actually re-coded the stay to "observation" and it was then covered. In another instance, I had to lean HARD on the ER doctor about discharging my mom after a traumatic fall resulting in a broken arm and several bones in her face. She needed residential rehab which wasn't possible to get without a hospital admission. Also, she could barely stand, was acting limb as a noodle, and there was no way she could go back to her independent living apartment with no overnight care, and our home had multiple flights of stairs and no spare room. Maybe call the hospital billing department and see if there is something they can do to help out?
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Reply to ShirleyDot
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