Medicare statement saying $0 is covered for hospital bill because of Hospice

I don't know all the answers, but hospice is supposed to limit hospital care, and we were told that meds not for the hospice diagnosis would not be covered. We would have paid for Moms Sinemet for example. I would guess that you could file an appeal of the ill on the grounds he needed the hospital stay for a painful condition related to his hospice diagnosis that was not manageable in a lesser setting. I hope that is helpful, because that's a horrendous bill to be stuck with!

There are strict policies with Medicare. In order for them to cover hospice, a Medicare approved doctor must see him first and then recommend hospice. When my mom was dying this past March, she was too fragile a state to be taken by ambulance to the clinic so that her doctor can request hospice. Hospice refused to come without doctor's order. Hospice told us that Medicare is very strict . They refused to come.

If you're father's hospital doctor is Medicare approved and the hospice accept Medicare, you may need to call both and explain the situation. Gather your documents. On that letter from Medicare, it tells you what to do if you disagree. .make copies for you before sending it off.

Worse case,they will reject it again. Then you can try if his supplementary insurance will cover it. You should have a packet from that insurance every year at renewal. It states what is covered and max it will cover each year.

Bookluvr, FIL is stubborn and in the event of adding to this living hell to put us all through, he refused to go to a doctor. His hospice order was signed by visiting nurse through a Registered Nurse Practioner who evidentally got her order signed from the doctor she works for. I honestly do not know if FIL ever saw that doctor (possibly just once). It is a franchise medical company that sends RNP and nurses out to check blood sugar, give meds (and prescrptions, etc). My guess is, it is going to come down to why the doctor he never sees, felt Hospice was needed. The Hospice here even said they would take the signature from a nurse practioner.

When you register into the hospital and clinic,the forms always ask for primary and secondary insurance. They will bill it first to Medicare. If Medicare refuses, they will let you know by mail. The clinic and or hospital or hospice will next bill it to your secondary insurance. I'd check first to see why Medicare rejected it. It could be something so simple as a missing document. Try calling Medicare?

Medicare said it was rejected because FIL was in hospice.

There should be instructions on how to appeal right on the rejection letter. Possibly someone at the hospital would help you with it too.

Joyce, my mom was in hospice service for over 10 years! Medicare covered it 80% and her secondary covered the 20%. It's all about following their strict procedures. Medicare will cover hospice for a limited time. When the time is running out, and if the doctor believes the patient needs ongoing hospice service, the doctor will fill out a form requesting this. Otherwise, the current orders end. and then you will need to re-apply for hospice. You cannot shortcut when it comes to Medicare. You need to figure out who ordered the hospice service, and follow up with them about the rejection and Medicare. Vstefans, there IS instructions on the back of the Rejection notice from Medicare on disputing their findings.

Bookluvr, wow! 10 years is is the longest I ever hear for Hospice (2 is usually the max). His nurses were initially telling us he had 6 weeks left. I honestly think they didn't want to bother with him anymore and after he pulled the gun incident, they didn't want to keep coming back in the house. I think they felt Hospice could maybe do more with him or in all honesty, let the chips fall where thy may. If he had not went to the hospital, he probably would have been dead.
A resgistered nurse practioner ordered Hospice. I am guessing she put the form in front of the doctor on file with the company to sign because my best guess is that this doctor saw my FIL once.
He was on Hospice at the time he went to the hospital and is not on hospice now. Our family has been asked to re-instate hospice and we have refused.
All his other bills have been paid by Meidcare and his supplement policy. This was the only one so far that has been a problem.

No, Medicare will only cover a set number of weeks. At the end of the weeks, the doctor can renew the request. If the doctor does not renew it, then he will need to reapply again. I learned this the hard way. Oldest sis did not tell me that mom's hospice was ending and that I needed to renew it. We only found out it expired when mom was dying and hospice refused to do anything without mom seeing the doctor. The doctor already told us that we have to take mom to the clinic. He refused to do house calls. The hospice refused to come to our home and do an evaluation. They were following Medicare protocol - except, i think the doctor could have done a home visit!

I don't know what went wrong with the last one. I think it must be some kind of paperwork...Difficult to say.

Bookluvr, that is sad. It all comes down to $$$.
They did tell us it was for a set number of weeks (I am thinking 9 or 12) and then it would have to be renewed. I am thinking he was on hospice 6 weeks or less (I am guessing about a month). They were more of a burdern to us than a help. I know every case is different, but I am understanding there are more families that have felt like we do.

Our hospice service is different. They assign us a nurse. She comes once a week if there's a current need for such service - to check mom's vital signs, etc... any bedsores? And that's it. They don't sponge bathe her. Just her vitals. And we were given a 24-hour emergency number. We're told not to call 911 but that number. Truly nothing for us to complain about - except that maybe they're charging Medicare for those hospice service. They're not here enough to become

a problem.... Sorry, I downloaded Google Chrome. I'm using Chrome instead of Internet Windows 8. This website AC and Chrome seem to be in conflict. Several times, my cursor freezes. Either that, or Chrome is not compatible with my laptop (being an old laptop).

Bookluvr, I stopped using Chrome. I had too many problem w/ my computer (I am guessing because my laptop is older, works fine on my husband and daughter's computers). It can get very aggravating I know.
There was a volunteer that came to give him a bath from Hospice. We considered that the only real help. FIL had a helper that came in every day and expressed concern many times to the hospice nurse about the sores on his legs (diabetic). She would wrap them and while she was doing so would ask the hospice nurse, "is this okay....and can you take a look at this because it looks really infected." The nurse would say, "oh yeah, you're doing it find, looks fine, bye." When FIL went to the hospital , the nurse on duty said he had never taken so much fluid off of a patient. They then asked me if FIL had skin grafts. I said no and asked why. They said, "his legs are so badly infected and in such bad shape, we thought he had skin grafts." We later found out he had MRSA, which has since been treated.
The nurse also would schedule a meeting with my husband and tell him, "I really need to meet with you to discuss important information about the progress of your dad." My husband told her he would have to lay off work for the meeting. He would then get to his dad's house and receive a call that she was going to be an hour or so late. Then she would show up and say, "hi, everything is the same, we are giving him more pain pills." Then walk out.
A chaplin showed up in a mini-skirt and said she was, "whatever religion my FIL needed her to be."
We had a 24 hour number which in our case was essentially an answering service.
They insisted my FIL get a hospital bed which he didn't want. So we had to move the majority of furniture out of the living room. He used it once and then went back to his recliner. They said that since we had a young child around FIL (she is 8) that they would bring in counselors, etc. to help her. Never was mentioned again.
I have helped caregive for 3 other people. All who died without Hospice. These were people who were sick for many years. It was actually easier than the experience we had.

Joyce, I don't understand what you mean by your question to hospice about whether it was a facilitate to die organization, and you were told no. You will need to appeal the Medicare decision but be very careful how you word your objection. It would need to be in agreement with whatever you may have to take to court because you may have a legal cause of action against the hospice group for and rolling you under false pretenses. Medicare sets the rules for hospice so I think they are fairly standard in all the states. I have had direct experience with Hospice in California. Here, in order to be on hospice, a doctor has to certify that they have 6 months or less to live in his or her medical opinion. The condition for which the patient is in hospice is also specified. Usually the term is 6 months at a time, either cancelable or renewable as the conditions warrant. During the time with in hospice, you are not allowed to treat the patient for the condition named as the hospice reason. You are allowed only together palliative or comfort care - pain medication, oxygen, etc. lf the pain becomes more severe, Hospice is allowed to increase medication even to the point of decreased respiration which can and will lead to the patient passing away. I kind of consider this facilitating doubt, don't you? And that's OK as long as that's what you wanted. But if that's not what you wanted, and you were told otherwise, you see where the false pretences may come in.

What you ARE allowed to do under hospice is treat a condition that is NOT the cause of the hospice evaluation. For example, if the patient is in hospice for Alzheimer's and becomes worse, you can't do anything to trade the Alzheimer's. BUT if the patient comes down with pneumonia, you don't have to but you CAN treat the pneumonia. AND it can be done at the hospital. Because we never had this circumstance, I don't know who pays but I presume it would be regular insurance, not Hospice. The rules for payment by disciple national company is generally that it has to be Medicare approved, so if Medicare doesn't approve the charge, the supplemental won't have to pay either. Medicare COULD approve the charge but page ZERO, in which case the supplemental should pick up the rest.

There are some intricate points at play in this case and since &18 thousand is at stake, you may want to consult with a lawyer before you write the Medicare appeal. As I said above, your complaint will have to be the same incase Medicare denies and you have to file a lawsuit, you can't change your stories in midstream.

as usual, corrections...I apologize that my android voice recognition is so lame

legal cause of action... for ENROLLING your dad under false pretenses

during the time WHILE UNDER Hospice

allowed only TO GIVE palliative

consider this facilitating DEATH, don't you?

you can't do anything to TREAT the Alzheimer's

rules for payment by THE SUPPLEMENTAL INSURANCE company

approve the charge but PAY zero

Since $18,000 is at stake.
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RE: HOSPICE

I would like to add there's a world of difference between groups. Our hospice had nurses on call who were in direct communication with the doctor, managing and upgrading patient medication, I health care worker 2 times a week who helped with showering or gave them a bed bath is the case was, and for my mom who just passed in January, the hospice nurse decided my mom was 'critical care' and provided LVNs round the clock 45 days while she was dying. Plez get a list of Hospice is from the hospital, talk to a couple of discharge case managers who work with the hospuce is all the time (since you often are getting a hospice evaluation in the hospital before discharge), and do some interviewing about their services prior to when you need them. IMHO, on top of everything else, you had a lousy Hospice.

Gather your paperwork, check to see why your dad was in hospice, was it for pain because of cancer, for trying to kill himself (a psych problem). Surely a building up of urine (which produces its own pain as well as becoming a medical emergency) and the inability of a nurse to properly cath him, can't in and of itself becoming cause to make someone hospice appropriate? I no I'm not aware of the entire case but this just sounds off to me.

My dad was on Medicare, in a NH, for a certain period of time. Medicare then dropped my dad (this was expected and I was in the process of getting my dad approved for Medicaid). The way we understood it, when we enlisted the help of hospice for my dad we were agreeing that we didn't want anymore medical intervention on his behalf unless it entailed comfort measures and comfort measures only. During hospice, we were still trying to get my dad approved for Medicaid. Had my dad wanted a hospital and had we taken him to the hospital our service with hospice would have been discontinued and my dad would have been charged for services he received at the hospital. And since Medicare had dropped my dad previously my dad would have been on the hook for that bill.

If he was on hospice at the time he went in the hospital, Hospice is responsible for the bill. They take over management of the medicare/medicaid or other insurance when they come in. Sorry you had a bad experience. Hospice is generally a very good service and should be in 6 months or more prior to death. They are very caring and helpful. Most people have misconceptions of what hospice is. They don't come in and take over the care, they don't stop other medications, or stop feeding them etc. Pain management is definitely a focus. A nurse will be in usually once a week to check on the family. An aid may be able to come in for a few hours a day to do personal care. They cover equipment and medications related to the terminal disease for free. They also have volunteers, spiritual help and education for the caregivers. You can opt out of hospice at any time and resume your health ins. and treatments if you wish.

Like every other service there are good and bad hospices and good and useless nurses within each.
The Medicare regulations that have to be followed are very strict. the Hospice receives a daily rate of payment for each patient and it is often difficult to pay for everything the patient needs within that amount. Some young patients use their primary insurance as long as it has a hospice benefit, otherwise they pay out of pocket on a sliding scale. many hospices hold fundraisers to help defray their costs. Hospices nurses typically are paid less than their hospital counterparts and receive lower benefits. making ends meet is a constant juggling game which explains why certain supplies are sometimes in short supply
The be eligible for hospice the patient must be certified to have a condition that can be expected to lead to death in six months or less. The MD must certifiy this and often will do so as long as they have seen the patient within the last six months. Often a patient's PCP will be a FNP or PA and the MD will never have actually seen the patient. an MD other than the PCP cansign the paperwork as long as they have been seeing the patient and often this will be someone like an Oncologist or renal specialist. Every cost associated with the terminal illness will be covered by hospice at their discretion so if you decide you want to go to the ER for some reason and it is not cleared with hospice first they won't pay.
Putting a catheter in a male patient can be very difficult if not impossible because elderly men tend to have enlarged prostates so there is no shame in not being successful at inserting a catheter but it is easy enough to check the patient for an overfull bladder and take him to the hospital where an MD can evaluate and treat. Hospice will usually pay those costs but if he refuses to come home when ready for discharge, hospice has the option to discharge him from their service. Hospice will continue to care for patients in hospital usually for five days when they will have either died or are waiting for nursing home placement. Hospice is able to continue to care for patients in N/H but only if the N/H allows it and many don't. If the patient leaves hospice normal nursing home Medicare/ Medicaid regulations apply.
Patients can be discharged from hospice if their condition improves and later be re-admitted for the same or another condition. The hospice may pay for things like radiation or chemo as long as it is of a palliative nature for example to shrink a brain tumor and relieve symptoms.
As most people know Medicare/Medicaid and any kind of health insurance can be an absolute minefield so question, everything, do your own research and demand answers which is not easy when you are dealing with end of life issues so the best advice is to be proactive when there is a family member with a chronic illness. Good wishes to all those doing and who have made the selfless sacrifice to care for a loved one.

jmcgrath - "If he was on hospice at the time he went in the hospital, Hospice is responsible for the bill" is true only if the hospitalization was related to the terminal diagnosis. And the hospice organization should work with you to make sure the bill is accepted by Medicare for payment if not (related to terminal diagnosis). I work for a not-for-profit hospice in the Midwest and am appalled at what I am reading! In my 11 years with hospice I have never seen any of the abuse and lack of compassion expressed in some of these comments. It takes the signatures of TWO physicians - not nurse practitioners nor physician assistants - to qualify for the first 90-day Hospice Medicare Benefit along with documentation and supporting medical reports. It then requires more documentation and physician signatures for the second 90-day benefit. After that, a face-to-face meeting between the patient and either a physician or nurse practitioner is required to continue your HMB in 60-day increments, each proving that the patient remains hospice appropriate.
My heart goes out to those families that not only had the heartbreak of losing a loved one while on hospice services, but then they also had horrible services with their hospice organization.

I had to take my Dad to the hospital. In order to make sure Medicare would cover it the hospice nurse informed me that I would have to sign a paper taking Dad off hospice. She told me this because she didn't want us to have a huge bill to pay. So I signed him out of hospice. This is the first thing they told us when I called and said we were going to take him to the hospital. I don't know why your hospice didn't do the same. Maybe you have a case against the hospice. The hospice said when he is better(we were thinking he had a stroke) call and he can be put back on hospice. The hospital said he would have to go to a nursing home and stay. They don't know what happened, but his mental condition is so bad overnight he will not be able to return home. They said after he received physical therapy to call them back in. He has kidney and cardiac problems.
It sounds as if the hospice is at fault for not telling you this.

This is a scary post! My husband will soon require hospice. I can't imagine facing that scenario PLUS the costs that you are stating. Where is the justice in any of this? It's always about the money, isn't it? Greed is so evil.

Joy, its true, I have written about this on this site before. I had a 4.5 hour intake for my Mom to go on Hospice. They promised me morning care daily and thats what I desperately needed. AFTER Mom was all signed up at my kitchen counter with me, the Nurse said, "now don't call 911 or take her to a Hospital, we will take care of everything for you." I was like "what!" I wanted details! She said that Hospice is now in charge and I have now chosen it over the expense and stressfulness of going to a Hospital and that my Mom will die at home. She continued to say that they can take care of everything, just call them. By day 3 I had no one because my Moms a difficult case, late stage alz. The first girl couldnt hoyer her into the wheelchair and the second girl couldnt roll her. I had phone calls, a nurse, chaplin, pt, ot people coming and calling and it was more of a p.i.t.a. than anything! I insisted they come and discharge me out immediately. they only offered "possible afternoon help" but they darn well knew my Mom napped afternoons and I only need help getting her up and bathed. I feel so bad for you. If Hospice did not tell you you couldnt go to a Hospital you will have to fight it. If your intake was like my moms, I , as her dpoa signed right on the nurses computer and couldnt read it first! She also never gave me copies she promised. During disharge I made her put in writing the date and that my Mother was now NOT under Hospice. I want my Mom to pass at home but if she should start to bleed profusely from her nose or a wound, etc, I want that assurance I can call my towns 911 for help. Obviously this wasn't made clear to you or you wouldnt have gone to the Hospital. Worse case scenerio, pay them $5 a month and after your Dad passes, isnt that bill null and void anyway?

PS I just remembered something else. I did ask Hospice right along, even before they came, if my Mom could keep her own doctor and they said of course, of course, etc. When I questioned them again after they told me about the no-hospital rule , they tweaked it to, "yes but you will have to pay for it, dont worry we can take care of everything." To me that pretty sneaky. Ohhhh yes you "can" go to the Dr, and you "can" go to the Hospital "but" you will pay!
I will not use Hospice unless my Mom is dying and in pain and if the Dr wont order her pain meds if she should need them.

As with all facets of medicine today, especially in cases with Elder patience where they are unable to communicate their own needs (but also in the case of children and even yourself -- why do you think the experts recommend a second opinion as well as taking an advocate with you), we all must inform ourselves about medical conditions and ask the right questions to keep the doctors and other powers that be from killing us.

Just today, I was told that the mother of a person I know who was taken to the hospital a couple of weeks ago is now going to have to undergo a second procedure to place a stent in her heart vessels, along with a second anesthesia that will be required, and all because during her first trip to the hospital, when she arrived at 6 a.m. one day, neither the attending Dr nor any of the supportive staff thought it important to call in a cardiologist until 3 a.m. the following morning. By the time the doctor arrived, she had been without care for 23 hours with a known heart insufficiency. The cardio was fuming, took it out on everyone in the ER and not any of them in the ER objected to the cardio's screaming about and throwing things (hmmm - demurily thought it was justified I gather). He needed to do angioplasty and place more than one stent. The mom's body however was weekend from the experience and she nearly went south on the operating table. They patched her up and send her home knowing she would have to come back in a couple of weeks, when she was stronger, for additional surgery. Already really bad, right? Now get this. Even after his justifiable tirade, the cardio is on willing to stand up for the patient and talk with a lawyer!

So, this post was meant to be about hospice although it might grated into other areas. There is nothing wrong with hospice or the concept of hospice. The problem is the people that are working at a particular Hospice. What we all need to do is what is legally referred to as "due diligence". Read here, read other places,familiarize yourself with the experiences other people have had. Develop I set of questions that are pertinent to your patient. Go out amongst the hospice people before you need them and ask your questions. Just like any sales person, ask if the answers they have satisfied you with are in writing in the contract you're both be signing. You won't be having any problems with the good ones, only the bad ones will balk at your examination of their processes.

In many cases, the case managers who do discharges at the hospitals are used to interfacing with the Hospices who are called into the hospital to evaluate for the appropriateness of hospice. These case managers probably cannot give you the one they think is the best but they probably can give you a list of 3 and those are the first that you should start checking on.

Please don't forsake the hospice concept all together. They can be very helpful in your loved ones and stage and you are not necessarily going to get that kind of cooperation from the primary doctor. Hospices are allowed to administer much more anxiety and pain medication fan and non hospice doctor is willing to do because he is differently under the scrutiny of the AMA and the DEA.

I have to say that I contacted Hospice at the daycare mom used to go to, and over the phone for 3 years of my Moms alz disease. I asked so many questions and I would not have Mom admitted to them until they could promise me morning care "and" that my Mom could keep her doctor. I was assured they just hired new CNA's and it was no problem.
Where did that get me? I only got 2 mornings of which they couldnt handle alone and had no one else, said Mom was a 2 person assist, yet I was there to assist so...? Also iif Mom went to the Doctor, YES she could go, but she had to pay. This was the best Hospice around I was told after I had tried one previously but ended up not signing on with them as they had no morning help available and couldnt even say when they could or would come. So, in the VERY end I suppose they might be good but they now take on patients years in advance. My Mom was given (only by Hospice) 6 months to 3 years and 1 year ago. When I questioned that they said they really cannot tell how long someone will live with asz disease but "oh no worries, we just re-evalulate and sign them on again every 6 months."
Joy, You're going to have to fight this, maybe get a lawyer. I think because the Hospice Lady couldnt get a foley in--you had no other choice. And that Social worker, shame on her asking about your FIL's money! All she had to do is have you sign a discharge paper from Hospice and it would have all been paid. I feel so bad for you!

I work for hospice. If the hospitalization was RELATED to his hospice diagnosis, then Medicare will not pay, the hospice will be responsible for paying it. If it was not related, then Medicare will pay. What should happen is that Medicare should have sent the bill to hospice to be paid, and then hospice should either pay it or resubmit to Medicare if it was for an issue unrelated to the hospice diagnosis. You need to take the bill to the hospice office and have their revenue coordinator or billing person resubmit to Medicare.