Making decisions with or for our loved ones while they are in the hospital requires more knowledge than many of us have -- especially if a decision needs to be made in 24-48 hours.
You are visiting your elderly parent in the hospital, driving back and forth, fielding calls from your siblings bringing them up to date and holding down your job -- exhausted.
Doctors, case workers, social workers and hospital personnel barrage you with information. While your primary focus is caring for your loved one - you've taken on a new role in managing their healthcare needs.
Here is a quick checklist I recommend to my clients @DrummAdvocacy.com
1- Have your loved one's insurance information with you. You want to make sure the charges are covered by the insurance company, if possible before the services are administered.
2- Immediately find out whom the caseworker is for your loved one. You can do this by asking the nurse or the nursing supervisor at the nursing desk.
Care managers and case managers are registered nurses who work in collaboration with your physician to determine when you are medically ready for discharge and that you have a safe discharge plan in place. They serve as advocates and educators regarding the discharge planning process. They also serve as a liaison between the medical team and your insurance company to ensure that the services you require are covered.*
3- Become involved with the discharge plan. Cold truth - health insurance companies cut costs by reducing the number of days a patient remains in the hospital. You have control over when your loved one is being discharged. Ask to meet with the caseworker with your loved one at the hospital. Find out how long the hospital stay is expected, and what plans and services are in place after the patient leaves. If you or the patient disagree, find out what rights you have under the hospital's grievance policy or the insurance company's grievance policy.
4- Find out how the insurance company makes decisions on continuing or denying coverage. Another cold hard fact, unless the patient is willing and able to pay out of pocket, once the insurance company denies coverage for the stay you will be facing the hard decision of your loved one going home before you feel they have recovered.
5- You have rights to appeal the insurance company's decision. But you have to know what the process is. There are very tight timeframes (in many cases 2 days) to seek an appeal. Find out who the decision-maker is and work in conjunction with the hospital's case manager. Follow up on the day the decision is to be made. Some insurance companies fax their 'decisions' over the weekend to health care facilities offices when no one is there.
*Excerpted from NYU Langone Health
