Hospice and emergency hospitalization

dofstadSeptember 27, 2013

My Dad was enrolled in Hospice with Lewy Body Dementia. He was doing well enough that he was close to being unenrolled. He was unable to ambulate on his own however and we had caregivers helping with his physical care. In August, he somehow got himself out of bed, walked back to the bathroom and fell. He was coherent but hurting. We had been told we're always supposed to call hospice first before an ambulance. We called the number we'd always been told to call and the nurse we usually worked with was out of town. We were told by the hospice program answering service that they would try to reach a nurse and have her call us. We waited for about 30 minutes with no call back while Dad lay on the floor. I finally called the ambulance and we had him transferred to the emergency room. I'll spare the details, but after determining he most likely had a broken hip, he ended up vomiting and aspirated. He passed away the next day. Mom now received a denial of all the claims for scans, emergency room, all tests, hospital stay etc. from the Medicare Advantage plan he was on. Now in the midst of her grief, Mom is absolutely beside herself with worry about this. As of now, I only get voicemails when I try to call and figure it out. I'm hoping someone can shed some light on this and how we straighten it out. Did we really mess up by calling the ambulance ourselves? I don't feel that this was trying to cure him for the condition he was enrolled in Hospice for, but I'm scared of red tape fiasco. Help!!!

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I don't think you did anything wrong regardless of what they say. Her died pure and simple, he needed an ambulance immediately. I don't care for hospice organizations. Some are good and some are not and you can't tell the difference until you have experience with them. one thing I do like is that you can fire them with a 30 day notice. I would not pay the bill, I would call again and leave a message if they won't talk to you and tell them the next call will be to your attorney.

I had a similar problem with a care home. About a year after my husband died, I got a bill for $500 and some for an ambulance. They had a van they usually take people to the hospital in. They said it was my responsibility. I thought about it for awhile then called the home and asked for the location and the phone number of their corporate offices. They told me the same thing, I had to pay. I Told them I would see them in court. She said that will cost you more than what is owed. I said, yes, but sometime you do it because it is the right thing to do. She said wait a minute, she returned and said don't worry about it. We will take care of it.

This post was edited by EmmaR on Sat, Sep 28, 13 at 19:07

    Bookmark   September 27, 2013 at 7:23PM
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do you get the automated system where you punch 1 for X, punch 2 for Y, punch 3 for Z, etc? If so, try punching zero repeatedly - that usually gets a 'live' person to speak with. Be polite but assertive that in no way was the trip to ER to extend his life but simply to assure he had no pain and that since Hospice had failed to call back with instructions after 30 mins you had no choice but to seek help elsewhere. Be polite but persistant.

    Bookmark   September 28, 2013 at 3:38PM
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I don't understand this (I don't know anything about Medicare Advantage plans) but I have never understood that being in hospice meant NO care and NO treatment.

    Bookmark   October 6, 2013 at 11:36PM
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Since there is no cure for Lewy Body Dementia there may have been a do not resuscitate order that was signed when your father was in better mental health. This would mean no taking him to hospital for treatment of any sort. If he did he should have talked to you about it. Perhaps he did but you did not understand or did not want to discuss with him.

If he had an order on file you should pay the bill. The hospice should have had it on file but if you were not on the list to release information they could not legally give you that information.

For your own sakes study Lewy Body Dementia as it is one of the dementias that can be genetic.

    Bookmark   October 7, 2013 at 2:37PM
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I think it's straightened out after many, many phone calls. Because it was a problem unrelated to the condition for which he was in Hospice, it was supposed to have been submitted to Original Medicare rather than Hospice or the Medicare Advantage plan. I think you misunderstood the situation, maifleur, we were very aware of the "do not resuscitate", in place, and we had the POLST order clearly posted. He was transported to the hospital for a hip fracture after a fall. When he aspirated, we told the doctor the wish was for no extreme measures and we requested (per the doctors advise and the prediscussed wishes of Dad) that he not be intubated. We let him go very naturally. Once again, he was only transported to the hospital because of an injury from a fall, and only after we couldn't reach a Hospice nurse. He laid on the floor in pain for 40 minutes - I'm sure all would agree it was not in anyway intended for us to leave him laying there. We're fairly certain that it will now be covered after being submitted to the appropriate insurer.

    Bookmark   October 7, 2013 at 3:11PM
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