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?
"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."
GM is lucky to have you.