Humana Medicare Advantage Denied hospitalization Louisville Kentucky

My mother, who has Humana Medicare Advantage health insurance was prematurely released (kicked out) of Mt Carmel East Hospital, Columbus Ohio, with an infected broken vertebra in her back and pneumonia in both lungs. Humana Medicare Advantage decided from an office somewhere that she was ready to go home when in fact she was not. She lives alone. She is not steady on her feet. She is in a back brace, on heavy narcotic painkillers, on 2-3  strong antibiotic drips with an IV “Picc line” in her arm, she cannot get out of bed, and cannot use the toilet without assistance. She clearly cannot take care of herself at all. Humana Medicare Advantage ORDERED them to send her home Saturday June 8th, 2013.

The attending physician tried twice with this so-called “peer to peer communication” talking to someone at Humana. This is supposed to be the last resort according to Humana. My mother’s doctor never even spoke to a medically licensed person; he spoke to someone at Humana, an administrator who took his message. The “peer to peer” communication actually never took place. Humana never called the social worker back with the decision either, she had to call them back to find out that we were denied 2 times. I also called Humana – I spoke to a Customer Service Rep.  He looked over my mother’s report and repeated to me that there was nothing else we could do. He told me that the “Regional Medical Director” had made this decision. I asked who this was and for a phone number, I was told that I could not have that information. I needed to write a letter and get Power of Attorney over my mother and formally submit the letter before anything would be changed.

She was sent home Saturday June 8^th. She was instructed that a Mt Carmel Home Health team would be coming every day for medications, every 2-3 days for baths and physical therapy. Mom had to order a hospital bed and a port -a- potty for her house. My mom had high anxiety over learning how to change her own IVs twice a day.

Monday morning June 10th the home care nurse was late showing up for her morning medications, mom was in severe pain, she accidentally took too many of one drug and could not get to the bathroom and made a mess on herself and her bed. She had not eaten.  No one showed until 1 PM that day, and then she ran a fever of 101.7. I was calling the home health people begging them to get there and clean her up. I live 30 miles away and work full time. The nurse reported the fever to the Dr. and the Dr. then ordered my mom to return to the Emergency Room Monday night. So we sat in the ER from 6 PM until 10 PM when she was finally seen by a Doctor. They kept her in an “ER Observation room” for the next 2.5 days until she was finally readmitted Wednesday June 12^th.

 I believe the stress and anxiety from being sent home too soon caused her pneumonia to worsen and set her back at least a week in her recovery. Supposedly she’s going to a rehab facility to deal with her bone infection healing after the pneumonia gets under control but I have not had any verification of this from Humana or any of the Doctors.  My mom is changing here health insurance as soon as she can to another provider.