Turtle

Even Lawyer Cook admits that the first move wasn’t “legit.”

Mrs. Jones’ Medicare funding for the original hospitalization is bound to have run out some time ago. Normally, Medicare will allow 90 days per admission, with an extra 60 “reserve” days, once per person, per lifetime. The patient is responsible for part of the bill from the first day of admission, and for the total hospital costs after the eligible days.

But there are still Medicare regulations to deal with in the case of “Medicare eligible” patients, even when they aren’t paying.

“Medicaid limits 2019” (a .PDF)

I certainly don’t know the Jones’ financial circumstances, and I may have over estimated the maximum income in early speculation. However, there are strict maximum Medicaid income and asset levels. These vary according to age, disability, and marital status. (Even the government bureaucratic Leviathan doesn’t want the spouse if a nursing home patient to end up indigent.)

In my experience, the social workers and benefits experts at hospitals and nursing homes are experts at negotiating and translating the bureaucracy. In addition, the disabled Medicare eligible person will have access to a benefits specialist. I’ve never had a hospital discharge and nursing home admission blocked by this “paperwork.” Certainly not for months at a time.

I can’t tell you why, but it’s true: Well below their “Donate Now” banner, Texas Right to Life (TRTL) is shamefully spinning another one of their false stories.

Just as they lied on their website that Chris Dunn was “slain“ by his doctors,

they now post that a woman, Mrs. Carolyn Jones, had to be “rescued” from hers, “racing” to another facility “in the middle of the night.”

Okay, it’s night in that picture. That and the proper names are the only things they got right.

Mrs. Jones wasn’t “rescued” from the hospital that has been giving her excellent care for over 6 months. Nor were her doctors and nurses “surprised.” that she was able to breathe on her own. After all, they were the ones who weaned her from the ventilator over a month ago.

What was expected was that Mrs. Jones would be transferred out if the hospital where she’s been admitted since November, 2018 to a more appropriate, lower level of nursing care two months ago.

On April 10, Mr. Jones testified to the Texas Senate Health and Human Services Committee that, thanks to the hospital doctors, his wife now needed the ventilator only “occasionally at night.”

The family were given notice that they needed to transfer Mrs. Jones in March. They’ve had another doctor and three facilities capable of providing the treatments she needs waiting to accept Mrs. Jones.

When the family of a hospitalised patient refuses to allow her to be transferred to a more appropriate treatment facility, the attending doctor has no legal means other than the 166.046 process laid out in the Texas Advance Directives Act (TADA). This is the legislation that has been called the “Futile Care Law” in the past, but TRTL likes to call it the” 10 Day Rule,” now, in spite of their rejection of effort after effort, etc., to expand the time frame and increase transparency and assistance. This is the issue that led to the rebuke (.PDF) of TRTL by the Texas Conference of Catholic Bishops and gleefully reported by the liberal press in Texas

The Jones family are real people, scared and hurting. Mr. Jones somehow was misled to believe the lie that “food and water” would be removed. I would have thought that at least one of the many, many lawyers at TRTL would have assured him that that is not legal under Texas law.

Instead, the Jones family’s fears – and your compassion – are being used as a means to TRTL’s political – and fundraising – ends.

And now, TRTL – in direct competition with – and with absolutely no mention of – Mrs. Jones’ family’s GoFundMe campaign – has been raising money in Mrs. Jones’ name. They state that the funds will be used for (TRTL) lawyer’s fees in addition to Mrs. Jones’ healthcare needs and that “excess” funds will go to help (TRTL’S) efforts for other patients.

I hope that TRTL’s money will also be used to pay for the very large hospital and doctor’s bills that the Jones family will receive. While there’s a chance that Texas Medicaid will pay for three months of medical bills, retroactively, Medicare doesn’t pay for hospitalizations over 90 days and has a 20% co-insurance (co-pay).

That’s bound to have added up in over 6 months.

We’ll just have to trust that TRTL won’t lie again.

Beverly B Nuckols, MD

Edit, Updated information:

One of the bloggers has told us more about that “rescue.” (Or today’s story, anyway.)

TRTL put her in a private ambulance and took her to *another ER,* one that couldn’t provide dialysis, so they then transferred her somewhere else.

There were comments about the first Hospital refusing transfer — no, refusing to be complicit with “dumping” a patient. Discharging to without ( or even with) acceptance of the transfer from the docs at the other facility is highly irregular and likely illegal.
Much has been said about funding. Yes. It appears that Medicare funding ran out, so no longer paying. 90 days per admission, with an extra 60 days over, under certain conditions.

About that Medicaid funding: I don’t know the limits of the mandatory asset tests, but the yearly income level is $60,000. One way to adapt is to spend money on medical costs.

Medicare makes it difficult to navigate the private pay process. When we had some question, we got informed consent, promise to pay, then performed the service, filed with Medicare, waited to be denied, then tried to Bill the patient. The risk is always a charge of “fraud and abuse.”

The same thing would have happened if the hospital had privately charged for Dialysis.

(5/20/19, BBN)