Medicare Planning Attorney
Protecting Your Rights Under Medicare in Cuyahoga, Lake, & Lorain Counties
Medicare serves as the bedrock of healthcare for Americans over 65, yet its coverage rules regarding rehabilitation and long-term care remain widely misunderstood. Families frequently confuse the medical treatment and short-term rehab covered by Medicare with the long-term custodial care covered by Medicaid. Unfortunately, this complexity can leave patients vulnerable when coverage is wrongfully denied or prematurely terminated by nursing facilities.
Law Offices of Daniel McGowan, LLC offers crucial support for seniors navigating the federal health insurance system and the transition from hospital to a skilled nursing facility (SNF). Our practice works to clarify these benefits and protect patient rights. Understanding the regulations regarding Medicare Part A benefits can save families thousands of dollars in out-of-pocket costs before they need to consider private pay or Medicaid solutions.
Speak with a Medicare planning attorney in Cleveland today to challenge unfair denials and protect your family's financial future. Call (216) 616-7592 or contact us online to schedule a consultation.
Maximizing Skilled Nursing Benefits
While Medicare Part A may cover up to 100 days of skilled nursing care per benefit period, accessing these benefits requires meeting strict criteria. To qualify, a patient must complete a "qualifying inpatient hospital stay" of at least three midnights before entering the facility.
Law Offices of Daniel McGowan, LLC advises clients on the critical distinction between "Observation Status" and "Inpatient Admission." Since Observation Status does not satisfy the three-day rule, failing to obtain a formal admission order may result in the denial of coverage for rehabilitation services.
Additionally, the financial structure of this coverage shifts after the first three weeks. Medicare pays the full cost only for days 1 through 20. From day 21 through 100, the patient is responsible for a significant daily co-payment, which must be covered out-of-pocket or by supplemental insurance. We assist families in planning for this expense and developing a strategy for care once Medicare benefits are exhausted.
Challenging Medicare Non-Coverage Notices
Nursing homes frequently issue a "Notice of Medicare Non-Coverage" (NOMNC) to signal the end of therapy, often claiming a patient has "plateaued" or ceased to improve. This rationale frequently stems from a misinterpretation of the "Improvement Standard."
Under the Jimmo v. Sebelius settlement, Medicare coverage cannot be denied solely based on a lack of improvement; rather, coverage remains available if skilled care is required to maintain the patient's current condition or prevent deterioration.
Law Offices of Daniel McGowan, LLC guides families in filing immediate appeals with the Quality Improvement Organization (QIO) to challenge these terminations. By legally contesting the facility's determination, we can often extend Medicare coverage, preserving access to entitled rehabilitation services and delaying the transition to private-pay billing.