Recovery Care/Short Term Care

[somarco]

This is also an issue with MAPDs.

I wonder how many agents do not know this?

 

[tcianflone]

Did Aetna have credible stats on how often the 3 day rule is applied?

Did they also discuss the 3 day waiver?

No stats were offered on the webinar that I recall.

 

[tcianflone]

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.

I wonder how many agents do not know this?

This comment didn't square with me, that a prior hospital stay would be required for SNF to be covered, so I checked the EOC for three MAPDs available in Broward County, FL. The language of all three EOCs are clear that a prior hospital stay is not required for the plan to cover a SNF stay. Here are the citations:

Aetna LPPO
Days covered: up to 100 days per benefit period. A prior hospital stay is not required. We will only cover your stay if you meet certain Medicare guidelines and your stay is medically necessary.

Humana LPPO
You are covered for up to 100 medically necessary days per benefit period. Prior hospital stay is not required.

UHC Regional PPO
A 3-day prior hospital stay is not required.

 

[rmhaire]

This comment didn't square with me, that a prior hospital stay would be required for SNF to be covered, so I checked the EOC for three MAPDs available in Broward County, FL. The language of all three EOCs are clear that a prior hospital stay is not required for the plan to cover a SNF stay. Here are the citations:

Aetna LPPO
Days covered: up to 100 days per benefit period. A prior hospital stay is not required. We will only cover your stay if you meet certain Medicare guidelines and your stay is medically necessary.

Humana LPPO
You are covered for up to 100 medically necessary days per benefit period. Prior hospital stay is not required.

UHC Regional PPO
A 3-day prior hospital stay is not required.

But here's what you're dealing with in the real world:

Most rural areas do not have brick and mortar SNFs. Your choices are nursing homes that are SNF certified or HHCs that are SNF certified.

And it's the 4th day and forward that's important. Some HHCs refuse to accept MA patients. I know of two in my area that will only take you if you're on OM.

 

[somarco]

Something I learned soon after joining this forum (the predecessor) is this.

What happens in Georgia is not necessarily the way things work in other parts of the country. As @rmhaire noted things are different in Albany (GA) vs Atlanta.

 

[tcianflone]

But here's what you're dealing with in the real world:

Most rural areas do not have brick and mortar SNFs. Your choices are nursing homes that are SNF certified or HHCs that are SNF certified.

And it's the 4th day and forward that's important. Some HHCs refuse to accept MA patients. I know of two in my area that will only take you if you're on OM.

Yes, things are different in your area, I see that. Here, we see MAPDs typically dragging their feet to get a patient admitted to SNF from the hospital. Then, once they are in SNF, the MAPDs want to push them out much earlier than the doc and the family think they should go home. Appeals, denials, rinse, repeat.

 

[somarco]

Here, we see MAPDs typically dragging their feet to get a patient admitted to SNF from the hospital. Then, once they are in SNF, the MAPDs want to push them out much earlier than the doc and the family think they should go home. Appeals, denials, rinse, repeat.

Are you OK with this?

 

[tcianflone]

Are you OK with this?

Do I have a choice? If you're going to be on managed care, you have to expect your care to be managed, no? Me, I'm not on manged care.

 

[somarco]

f you're going to be on managed care, you have to expect your care to be managed, no? Me, I'm not on manged care.

Isn't that a contradiction?

You offer a product you don't (won't) have . . .

 

[tcianflone]

Isn't that a contradiction?

You offer a product you don't (won't) have . . .

We have some of the highest Med Supp premiums in the country in SE FL where I have the bulk of my business. A good many of the folks here cannot afford to be on original Medicare with a Supplement, so, yes, I sell MA. I always present OM w/Med Supp first, even high deductible supps, to see if they can swing it. And I educate them about how MA works with all of its DISAdvantages. Not a contradiction for me.