By skyforbes Hi, my mom is in a minimally conscious state and was transferred to a hospital from her LTC facility because of a respiratory issue. She was admitted to hospital as having pneumonia and a UTI. She is approved for Medicaid but will not be managed under an HMO until June 1st. She still currently has a private insurance plan through the states subsidized plans for low income. She was stabilzed and medically cleared after a week. I attempted to get her to an acute rehab specializing in disorders of conscious and stroke. The hospital did multiple therapy evals and was medically approved for rehab by the hospital and the rehab. The hospital advised her private insurance has to be cancelled or there can be penalties with Medicaid. It is also possible acute rehab needs prior authorization and since she is unmanaged the hospital could not run an auth with Medicaid to get her to rehab?
So the hospital requested auth from her private insurance, it was denied and appeal denied also. I had no choice but to send her back to the LTC facility. As soon as we got her back there has been nothing but issues, they transferred her medications list incorrectly and have still did not correct it in their system after 3 days, and other issues with her given a speaking valve from the hospital, that I'm not allowed to continue it's use until she's evaluated by their facility Drs.
Their therapy director did his own eval today and he did not recommend therapy like the hospital did, and only recommended she be sat up in a chair everyday. Once her Medicaid becomes managed I hoped to run the authorization again with them to get her to the rehab. Can the record and eval from LTC effect Medicaid's approval to transfer her to the rehab? Even though there was a recommendation a week ago from the hospital?