Hospice and Medicare Advantage

darmok

Recently my mom was sent to the emergency room. The insurance company refused to pay the claim because she is under hospice care. Medicare also refuses to pay so the bills are coming back to her. When you go into hospice care does that mean you lose all your other benefits?

dayn2nite2

If she's on hospice, why was she sent to the ER and who sent her?

loveskitties

Part of the hospice rules are that the patient will not be sent to ER/Hospital for the existing condition.  Usually, if determined Hospice will cancel and then insurance will take over.  Once the need for hospital is over, can get back on hospice.

Before my dad went on hospice we directed MC to not send him to ER unless specifically ok'd by one of family.  This was because of frequency he had been sent, and doctor's had said that lots of tests could be done, but unless we were willing to put him thru treatments it was a useless thing to do.  We all agreed that unless in pain, bleeding or mental agitation there was no need for more ER trips.

It is not usual for Hospice to ok ER trip unless unrelated issue.  If it was perhaps Hospice can talk to the insurance about that.

CanyonGal

Lovesskitties is correct.

 (1) Hospice removes you from care,(my mother's facility worked with the hospice team and I consulted with the hospice nurse - I live in another state)

 (2) regular Medicare or your Medicare Advantage takes over (because you are seeking medical care), and

 (3) once you are discharged, request that the hospital contact Hospice to place you back under their care.

Sounds like someone dropped the ball in explaining how this works. I didn't understand it either. I was fortunate that the hospice social worker was in the room and it all came together before she was transported to the hospital and when she was discharged. She was sent to make sure she didn't have a blood clot in the leg (which she previously had one there) and that wasn't something Hospice could treat. (When she arrived at the hospital, they found LOTS of problems which they were able to treat. She was pretty catatonic when she was released so it helped getting some issues cleared up, but the IV, xrays, etc. played its toll on her system.)

 If it was a true emergency, like a fall with serious injuries, I think we all go into reaction without thinking. But try to remember to call Hospice to alert them to what is happening.

stevenferg

Hospice care gives you the opportunity to offer your loved ones the care they need in the last few days. As discussed earlier, there are four levels of hospice care, including routine care, continuing care, inpatient care, and temporary care. Four levels of hospice care are defined by Medicare to meet the different needs of patients. I asked td {border: 1px solid #cccccc;}br {mso-data-placement:same-cell;}http://www.thefinitygroup.com more about these levels and benefits. They told me that if they give you temporary assistance, then there is a chance not to lose your leagues. In other cases, unfortunately, you lose all benefits.

Wyfreak

My mom in memory care on hospice

and sometimes they do go to hospital if they 

are not DNR