My mom has Interstitial lung disease and 5 % breathing capacity due to scarring. She was in the hospitial 2 weeks and medicare initially turned her down to go to rehab. The pulmonologist called United Healthcare to do a pier to pier review in which her Pulmonologist told the medicare Dr that she was unable to go home and take care of herself. ( cannot walk, bath or open a water bottle) Medicare denied this appeal from the Dr. So we did a family appeal and they granted her 2 weeks in rehab. After 10 days of rehab the case worker communicated with medicare to tell them she needed more time. DENIED! My sister appealed over the weekend and was granted the appeal. Medicare just called to tell us that they are turning over the appeal and it is DENIED and her release date is tomorrow. My mom is staying and paying!!!! These are all facts and not opinion, fortunately mom has a little savings to take care of herself. This has been my experience with government healthcare and I am keeping my opinions to myself, with the confidence that I do not need to write it out. I hope that we are unlucky, but fear that is not the case.

Sorry to hear that and thanks for sharing.

Won't be surprised when we see euthanasia offered as an alternative.

Dangit man

This sounds like a situation where they’re rationing care which is necessary and reasonable in both private and government healthcare. Can you look into another avenue to get care such as home care? It may cheaper for Medicare which could result in approval.

It’s hard to get the full picture because your grammar is terrible and there’s private details you shouldn’t share.

My experience is that if Medicare denies it, the Doctor's office plucked it up. Luckily I just call rhe VA and I am back in business.

People like to dump on the VHA because it’s evil government healthcare, but they’ve been great to me. I Just had ACL reconstruction surgery through them and the experience was smooth.

Going thru the same thing

Yall are both in many of our thoughts and Prayers gentlemen.

If United Healthcare is involved, it is not Medicare. It is a Medicare replacement.

Sorry about your mom.

Really sucks that such a good family is being run through the wringer. Ramsey your mom is still in our prayers.

It really sucks that Medicare is putting a few bucks ahead of someone's well being. I had a similar experience with private insurance.

That has to be real tough to deal with, prayers sent!

Sorry you are still having troubles Ramsey. Your mother is in my daily prayers.

Depends on which carrier you use.

It sounds to me like she has a Medicare supplement policy with United. If that is the case then Medicare is the primary insurance and typically would pay for 80% and United is the supplement and typically would pay for the other 20%.

It must be Medicare who is refusing the rehab -

Sorry about your sweet Mom Ramsey.

Medicare is great........till it's not. it gets very confusing.

X3 Sorry to hear this Rams

My mom had a stroke back in 2020 and United Healthcare would only approve 1 week of rehab. It was absolutely infuriating trying to deal with them. I do not envy you sir.

Our frustration has been the process. When 3 Drs tsking care of a patient communicates to Medicare that the patient needs another week and there is no way she can go home. They denied it anyways.

Ramsey, Does she by chance have Medicare Advantage or regular Medicare plus a United Healthcare supplement?

I'm curious because I've been on regular Medicare plus a supposedly good supplement for just over a year and luckily haven't even used it except for one ear exam. When I was signing up everyone I consulted told me do not get Medicare Advantage. Even my regular doctor's office strongly hinted that message as well. I think they have to be careful what they say.

More than likely it is a Medicare Advantage plan and not a Medicare Supplement plan. Different rules for the two different plans.

This is most likely a medicare advantage plan through united healthcare. Those are really decent plans up front but they suck for some things, and rehab must be one of those things that they suck at.

Regular medicare does have a limit to rehab as well, but with regular medicare if the dr requests it, it is done. There will be co-pays and 20% that isn't covered (possibly secondary insurance will, many times it doesn't), but medicare is actually pretty decent with end of life type care. The medicare advantage plans are not typically good for end of life care, and I have said for along time they are generally good as long as you are healthy but if you are a sick person (Interstitial lung disease is not a healthy person) then a advantage plan is not for you.

I am sorry for the problems your mom is having ramsey. One option, not a poopular option, but if she doesn't have much money or assets, is to let her get medicaid as well and then she can use that coverage or it can at least help. Some hoops to go through to get that, but it may help. Of course then you are dealing with medicaid facilities and those aren't always the nicest, let alone the best...