Recovery Care/Short Term Care

tcianflone

Expert
41
Just came off a webiner about the Aetna Recovery Care supplemental product. Unfortunately, not available in Florida where I am. These products address the problem with Original Medicare with a Supplement where patients may be sent to skilled nursing/rehab before they have a full three-day inpatient stay in a hospital. When this happens, Original Medicare won't cover the SNF stay. Hospitals can get creative with hospital stays, coding them as "under observation", thus putting patients at financial risk for a SNF stay even after they've been in a hospital for days. So, what are your thoughts on this type of coverage? What products do you like for this type of coverage? If you know them to be available in Florida, that would be a plus. Thanks for your insights.
 
tcianflone said:

These products address the problem with Original Medicare with a Supplement where patients may be sent to skilled nursing/rehab before they have a full three-day inpatient stay in a hospital.

This is also an issue with MAPDs. FL is a tough state for STC plans.

I bought myself the Aetna Recovery Care plan (I'm in PA) last year. There should be a webex on the Aetna Senior Supplemental website.
 
tcianflone said:

These products address the problem with Original Medicare with a Supplement where patients may be sent to skilled nursing/rehab before they have a full three-day inpatient stay in a hospital.

This is also an issue with MAPDs. FL is a tough state for STC plans.

I bought myself the Aetna Recovery Care plan (I'm in PA) last year. There should be a webex on the Aetna Senior Supplemental website.
Here almost anyone with a MAP is denied residential rehab for many conditions that with OM they'd have, but especially with hip and knee replacements. Instead they can get in home physical therapy, typically 2x a week which may not be enough - especially if they initially need more assistance than that. It's an issue here for sure.
 
Here almost anyone with a MAP is denied residential rehab for many conditions that with OM they'd have, but especially with hip and knee replacements. Instead they can get in home physical therapy, typically 2x a week which may not be enough - especially if they initially need more assistance than that. It's an issue here for sure.

I wonder how much of this phenomenon where patients are told they need more rehab is a function of the providers just wanting to milk more rehab dollars vs the patient actually needing more rehab .I know that once the provider tells them they need more rehab whether it's true or not the patient is going to be mad at the insurance company if they don't get but on the other hand i'm not aware of any MA members or original medicare patients being mad because the home health came to often or too many times for what was actually required.
 
Just came off a webiner about the Aetna Recovery Care supplemental product. Unfortunately, not available in Florida where I am. These products address the problem with Original Medicare with a Supplement where patients may be sent to skilled nursing/rehab before they have a full three-day inpatient stay in a hospital. When this happens, Original Medicare won't cover the SNF stay. Hospitals can get creative with hospital stays, coding them as "under observation", thus putting patients at financial risk for a SNF stay even after they've been in a hospital for days. So, what are your thoughts on this type of coverage? What products do you like for this type of coverage? If you know them to be available in Florida, that would be a plus. Thanks for your insights.
GTL and Manhattan have STC Recovery plans and stand alone Short Term Home Healthcare policies.
 
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I wonder how much of this phenomenon where patients are told they need more rehab is a function of the providers just wanting to milk more rehab dollars vs the patient actually needing more rehab .I know that once the provider tells them they need more rehab whether it's true or not the patient is going to be mad at the insurance company if they don't get but on the other hand i'm not aware of any MA members or original medicare patients being mad because the home health came to often or too many times for what was actually required.
That I do not know. I do know of 3 credible cases where they were told they were going to residential rehab because of their hip replacement plus other issues, in a fourth case it was a stroke with other issues and the MAP denied it. In those four cases they were really struggling to do ordinary daily things like cook, get out of chairs, take a shower, etc, The rest is just hearsay of people complaining about what had happened to them. Here the 4 main hospital systems don't own the residential rehab that gets used by most so not sure there'd be a financial interest by the hospital system. But then again who knows what goes on behind closed doors.
 
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That I do not know. I do know of 3 credible cases where they were told they were going to residential rehab because of their hip replacement plus other issues, in a fourth case it was a stroke with other issues and the MAP denied it. In those four cases they were really struggling to do ordinary daily things like cook, get out of chairs, take a shower, etc, The rest is just hearsay of people complaining about what had happened to them. Here the 4 main hospital systems don't own the residential rehab that gets used by most so not sure there'd be a financial interest by the hospital system. But then again who knows what goes on behind closed doors.

Another thing i am seeing more of recently is family members who are upset about mom being kicked out of SNF because they don't want to hire a private home health aide to to help with activities of daily living while they recover at home.Amazing how many people think the government should pay for this .
 
Another thing i am seeing more of recently is family members who are upset about mom being kicked out of SNF because they don't want to hire a private home health aide to to help with activities of daily living while they recover at home.Amazing how many people think the government should pay for this .
Well paying for that is part of some MAPs, although not usually part of OM so the expectation of it being paid for if it is listed as a benefit is appropriate. If you don't think it should be a benefit that is a separate issue from what is a benefit for some.
 
Did Aetna have credible stats on how often the 3 day rule is applied?

Did they also discuss the 3 day waiver?
 
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