General Question

WestRiverrat's avatar

Who do I contact to cut Medicare red tape?

Asked by WestRiverrat (19915points) November 14th, 2012

My dad is in a nursing home with necrosis in his foot and renal failure. He refuses surgery and dialysis. His doctor wants him in hospice care.

The problem is he has been in Hospice care since his renal failure was diagnosed 4 years ago. Medicare says they will no longer pay for hospice because he has been on hospice for too long.

We do have a lawyer working on it, I was wondering would it help to contact his Senators and Congressman? I want to, but mom and my sisters don’t want to bother them. For the record, my dad confirmed his current Senator and baptised her kids.

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14 Answers

Kayak8's avatar

A call to one’s representative or Senator (particularly if you know the person) is always a good way to go. I work for our state’s health department and when we get a call that a rep or senator is trying to seek help on behalf of a consumer, it gets immediate action and we have to confirm what we did to help the person all the way up to the Director. This is a very effective strategy!

YARNLADY's avatar

If you already have a lawyer, talk to her/him. You pay the professional to do the work for you.

marinelife's avatar

I agree with your plan to approach the Senator’s office. Be sure and tell them of your father’s relationship with her.

SpatzieLover's avatar

I believe you’ll have to go through an appeals process with Medicare.

Also, you should contact a social worker from your dad’s county and inform them of your situation. We had a lot of pull just through our social worker.

ETpro's avatar

@WestRiverrat I agree with the advice of @Kayak8, @YARNLADY, @marinelife and @SpatzieLover. I’d just like to add a personal note of sympathy to you, and praise for hanging tough to tough to let your dad go with dignity, and live as well as he can till he must go. I believe my kids would do the same for me, and as I age, that’s a tremendous comfort.

WestRiverrat's avatar

@SpatzieLover it was his social worker that suggested calling the Senator.

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Cupcake's avatar

I thought as long as your physician certified the need for hospice (which includes the forecast for <6 months expected life), hospice was recertified each 60 day period an unlimited number of times. I don’t understand why his hospice would be denied, unless the doctors no longer believe he has less than 6 moths to live.

Anyway, it’s not my area of expertise. I found the following online:

You can get more information about hospice care from:
● The National Hospice Organization 1901 North Moore Street, Suite 901 Arlington, VA 22209 1 800 658 – 8898 (on the Internet)
● The Hospice Association of America 228 7th Street, SE Washington, DC 20003 1 202 546 – 4759 (on the Internet)
Call your State Hospice Organization to find a hospice program in your area (see phone numbers on pages 15 – 20).
At the time of printing, these phone numbers were correct. Phone numbers sometimes change. To get the most updated phone numbers, call 1 800 633 – 4227 (TTY/TDD: 1 877 486 – 2048 for the speech and hearing impaired) or go to the Internet at under “Important Contacts.” source

These insurance coverage situations are so difficult. I wish you the best!

bkcunningham's avatar

I want to extend my love and concern for what you and your family are going through. I don’t understand why Medicare isn’t paying for the hospice care.

If I were in your position, I would contact the Medicare Quality Improvement Organization for my state. This will give you information about the QIO. Best wishes.

janbb's avatar

Calling the Senator who knows your father seems like potentially the most effective line of attack.

WestRiverrat's avatar

I called the senator’s office last night, Medicare reinstated his Hospice care retroactive to when he went into the nursing home.

Evidently the problem was there were no tests on his kidneys since he was first admitted into hospice. Mainly because he and the Dr agreed that if he was not going to treat the renal failure there was no reason to do the tests. I guess they both forgot about the government’s need for documentation.

Now we just need to find a pain med that he can tolerate. It sucks being allergic to opiates.

janbb's avatar

Glad about the reinstatement and hope you find a pain med that works soon!

bkcunningham's avatar

I can’t take opiates. I have never been in an end of life situation though, @WestRiverrat. I’m sure the hospice people and his physician(s) will be able to find a good alternative.I know it is tough. Hang in there and know you have positive thoughts coming your way.

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