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Old 11-22-2011   #16 (permalink)
añejo
 
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Just thought I'd upate to those interested.

The "recosideration" was also denied so I am now seeking Administrative Law Judge relief. Have not heard on the date yet.

When Dad was released fromt he Rehab, he spent 4 days at home before having a relapse...turns out he had a raging UTI ( Iwas not aware that in geriatric patients a UTI can reek havoc with...both physically and mentally). My brother and I fought to get the ambulance crew to bring him to the hospital in my town versus the one in his town...night and day difference in care! They admitted him inpatient and he is now back at the rehab facility getting Phys Therapy.

One thing that has developed is that there is now a class action law suit in place dealing with the very issue we are dealing with..."In patient" versus "Observation" status. The law a suit can be read here
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Old 02-03-2012   #17 (permalink)
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Latest round of frustration and some relief:

Met with the ALJ on 19 Jan. It took all of ten minutes for her to rule on our behalf. The QIO representatives (essentially the defendant) did not show.

A week later, the judge's assitant calle dm back and told me there was a clerical error. The paper work provided the judge indicated the stay from the 30th of Sept throught he 3rd of October...not the original admittance of 26 Sept, which is what I was appealing. Since the Sept 26th dates were never officially "contested" at the lower levels (according to teh paperwork) the ruling she gave was negated and she had to find for the defendant. I was told I could either ask the QIO to "re-open" the case and look at it again or I could appeal her decision to the Medical Appeals Council.
Now, I'm not a smart man, but why would the appeals council find anything different with the same paperwork before them and why would the QIO re-open the case if they satnd to lose money?

So, on Tuesday, I found an office within the State Dept of Health and Social Svcs that deals with Medicare situations. The woman I spoke to dropped everything on her calendar and drove an hour South to meet with me! She said multiple cases of this have been cropping up and she wants to stop it! She is at the least, working for reimbursement and at the most, correcting the record of admittance.

It's not over yet!
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Old 08-20-2012   #18 (permalink)
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Yesterday, we spent the better part of the day being interviewed and photographed by AARP magazine. They are doing a piece to draw attention to the "Observation Status" issues plaguing seniors.
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Old 08-20-2012   #19 (permalink)
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That is good, but are all the other issues worked through to your satisfaction?
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Old 09-26-2013   #20 (permalink)
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Well, we lost the class action suit. The judge dismissed all claims.

While the decision seemed to agree that all the plaintiffs wrongly suffered significant costs, it dismissed the claims based on what the lawyers were arguing.

In the meantime we are really pushing for the passage of Representative Joe Courtney’s bill (H.R. 1179) in Congress (it’s S. 569 in the Senate). It would make all time spent in the hospital count toward the three-day stay requirement, so that would be a different way around this problem.

Amy, not sure if you're at all interested, but I have a copy of the decision I can email you.
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Old 10-04-2013   #21 (permalink)
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Gosh what a terrible ordeal you have been put through. I will have to keep an eye out on my mom's paperwork when she goes to the hospital. Really scary!
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Old 09-09-2017   #22 (permalink)
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Another update...yes, it's still going on!

After Dad passed, the Lawyers for the Medicare Advocacy group asked me if I'd be interested in continuing his case as his representative. I agreed.
As mentioned above, the initial attempt failed. However, the appeal worked and the case is being heard again. So far, things are looking positive. This movement is gaining steam!

The lawyer sent me an email Thursday with a link to a magazine article that's covering the case...thought you'd like to read it (don't worry, it's short).

https://nyti.ms/2xDznH5

A great example of what Dad went through and it's happening across the country every day.
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