Covering the Bases: Long-term care limits | Maryland Gazette (HometownGlenBurnie.com)

This is a common misconception that people learn correctly only after they have experienced the care.

Coverage for people in rehabilitation facilities or skilled nursing facilities is covered by Medicare only if the care received is considered skilled care, and Medicare only helps to pay for the first 100 days of care. Custodial care, which is a level of care which doesn't usually require a nurse, physical therapist, speech therapist or occupational therapist, is not a covered benefit.

Long-term care insurance is asset protection, which may allow you to pass on some of your estate to the benefactors of your choice. It is expensive and doesn't cover every single possibility which may be involved in long-term care, so it's important to understand the product you are considering buying before you sign on the dotted line.

During my mother's last hospital stay, she received a Notice of Noncoverage on her fourth day in the hospital. We didn't think she was well enough to be discharged yet, but the doctor said she was OK to be moved to a skilled nursing facility.

We went along with his recommendation, but I think we should have tried to get the hospital to keep her for another few days. What should we have done?

A Medicare beneficiary has the right to appeal after receiving a written notice from the hospital about the planned date of discharge. This document is called a Notice of Noncoverage, and it means that the hospital and/or your physician feel that Medicare will no longer cover your stay in an acute care facility. If this information is given to the patient verbally, he or she should request it in written form.

The information about appealing the discharge will be provided to the patient on request, and the appeal will trigger a review of the patient's case by a Quality Improvement Organization (QIO). The timing of the appeal is very important, and the patient will not be billed for the days in the hospital during the QIO review if the appeal is filed by noon of the day after the noncoverage notice is received.

The QIO will render a decision within one day after it receives all the necessary information. If a patient stays in a hospital after the planned date of discharge without filing an appeal, it is likely that your charges for additional days in the hospital will not be covered by Medicare.

Medicare states that the patient has a right to know about any decisions that the hospital, doctor or health plan makes about your hospital stay and who will pay for it. You should always exercise this right.

Susan Knight is a senior health insurance consultant. If you have questions about the information in this column, call 410-222-4464.