TKR Same day surgery release for 83 year old

[meishere30]

The insurance confuses me, but his case worker assured us Humana HAS to be the primary. And yes I actually am self employed but I'm the only employee....I did plan on being with him constantly for at least 5 days ...but after that I absolutely have to go back to work....

 

[meishere30]

And not sure if I stated but he actually needs a double tkr....but because of his age ....opted for one at a time....point being after surgery he's not good have great strength in his other knee

 

[subie2021]

@meishere30 I'm a hippie not a knee-er here but just happened to see this thread.
It sounds like your dad has an advantage plan. They are indeed the primary and have a fit if anything is billed to medicare instead of them. The elective thing only means that this surgery isn't a a medically urgent or life or death type operation, like an obstructed bowel or broken hip.
My surgeon assumed I wanted an overnight in the hospital, but I asked for a same day release. He was OK with that because, according to him, if he schedules for same day he is able to order another night(s) if the patient isn't ready to go home. That includes medical reason like low BP, or functional reasons like not being ambulatory or being a fall risk.
But if he schedules for overnights, he can't release his patients early.
When my sister had her surgery, she had a problem on the day she was supposed to be released (a day or two in the hospital). She wasn't able to do stairs or bear any weight on the operated leg. So she went to a rehab facility for a few days, where she got the nursing care she needed and the appropriate PT to get her moving.
Talk to the person at the surgeon's office about all this. They will most likely explain everything to you, or be able to run interference with your dad's insurance.
Good luck to you and your dad.

 

[meishere30]

Thank you, so much! Yes Monday morning my first call is to his doctor/surgeon ....see if he even knows they're scheduling same day release....thanks again!

 

[Jamie]

What you describe isn't making sense to me. If a person has Medicare, that always is the primary. Then you might have a "gap" policy (supplemental insurance with Humana) that covers the copays. The only exception to that is if he has purchased one of the Medicare Advantage plans. They tend to be very unreasonable at times and require battles. Your surgeon's office should be able to help you navigate this. Hopefully you have talked to them by now and are getting help to sort this out. Don't give up! That's what the insurance companies want you to do.

 

[meishere30]

Jamie.... Actually you sound like you're right on point because it's his Humana which evidently is a advantage plan that is causing the problem.... For some reason they have to use that as the primary I've talked to the doctor and the doctor said that they've been fighting it for the last 2 weeks and are getting nowhere with the insurance company... So at this point with the time deadline the easiest thing we're going to do is switch our insurance companies before the December 7th deadline and reschedule his surgery for next the beginning of next year

 

[meishere30]

So am I correct in understanding.....he should have Medicare as primary and Medicaid as secondary.... I'm really struggling with getting any guidance from State agencies about choices to make...

 

[Wordwizard4538]

Some of this stuff is due to hospitals being full of Covid patients. I had a partial Monday and am only 61 and very healthy, had 18 stairs to get in house. Honestly the block they give you to the knee keeps you comfortable for 24 hours, then holy cow, the pain hit. Hopefully they will keep him if he appears to need admission. This same day surgery is getting out of control. Eight years ago I stayed two nights for a partial, now it's out the door.

 

[subie2021]

@meishere30, talk to the insurance person at the surgeon's office and ask which company is easy to work with, which gives them the least grief, etc.
Then contact an independent health insurance agent and get their input as to price and any other concerns.

 

[HelenaM]

My husband had a tkr done in July with Medicare. We were told it would be same day surgery, and I simply told the surgeon I was concerned because he was 79. The surgeon said because you asked ( I think he meant that by asking I showed I felt concerned), he would be staying at least one night. He actually stayed longer. We have a ground floor bedroom/bath and he needed help for a week or more, but less help every day. I hope they will adjust for you.

 

[Pumpkin]

Then contact an independent health insurance agent and get their input as to price and any other concerns.

This is great advice, find a reputable agent in your community, they can guide you through the process.
December 7th is the last day to change Medicare plans.

 

[montanagal]

Some of this stuff is due to hospitals being full of Covid patients.

My town has two dedicated ortho surgery centers and I'm not sure they ever took any covid patients or whether they ever had to shut down last year. Mine still kept me overnight.

I'm not sure what's going on with surgery centers - is this a trend in the States?

 

[meishere30]

I have calls into many agency's asking for help to guide me thought the insurance process...I'm unsuccesul so far....how to I change his coverage?

 

[meishere30]

Do I contact Medicare and they change it? I've been advised by surgeon assistant and social worker that he need Medicare as primary and straight Medicaid....no advantage plans....he should qualify cuz he's low income ...I'm so lost and working against the deadline

 

[Rain Dancer]

Have you read the materials at medicare.gov? It explains advantage plans and provides links to determine what is available in every state. Fyi, my mother is low income in PA and has an advantage plan. The state pays for Medicare Part B costs. If agencies do not respond, you may have to look at the policies of the individual insurers by contacting them directly or reviewing their materials on line. Time is critical--you have only until December 7 to make a change. I also suggest that you contact your local senior services agency to see if they provide comparisons of policies or contacts who can assist.

 

[Rain Dancer]

Do I contact Medicare and they change it? I've been advised by surgeon assistant and social worker that he need Medicare as primary and straight Medicaid....no advantage plans....he should qualify cuz he's low income ...I'm so lost and working against the deadline

The local senior services centers receive funding from the federal government and are your best resource at this point. For example, the local Pennsylvania senior services centers specifically provide Medicare counselors. Please send me a private message and I can help you locate the local office. They are usually at the county level.

 

[beesknee]

If he is in no condition to leave the hospital, I'd be surprised if the hospital would risk a lawsuit sending him home when he is not ready. The physician would need to release him.

 

[Jamie]

So am I correct in understanding.....he should have Medicare as primary and Medicaid as secondary.... I'm really struggling with getting any guidance from State agencies about choices to make...

I didn't realize Medicaid was involved too. Medicaid coverage varies by state, so I'm not going to be much help for you there. You need to contact a senior services office to help guide you through the insurance process. It's a free service, but as Rain Dancer said, you only have a few more days to apply for a change in coverage for him that would start next year.

Since you are in Genessee county in Michigan, I suggest you start at the county office for senior services:

Senior Services

Welcome to Genesee County Michigan

www.gc4me.com

If they cannot help you directly, I'm pretty sure they will know who you should be contacting for help.

 

[meishere30]

I want to thank everyone for sharing yr personal experiences, advice and help pointing me in the right direction....my dad has chosen new insurance coverage, Medicare original as primary, Medicaid and a prescription plan....I'm assured my social worker and surgeon this is the best....we have postponed his surgery till March and he is scheduled for a shot tomorrow to tide him over till surgery....thank you all again....I have alot more to learn but I'm on the right path

 

[Jockette]

I’m so happy things worked out well for you!

Please come back in March when he has his surgery, we will support you every step of the way.