My Rehab Story

This section on my personal website started out as a Facebook post. I wanted an easy way to document my rehab journey and also share with my family and friends some of my reflections and experiences while in a skilled nursing rehab facility. I place these pages here with the hope that the information contained therein may be useful to someone.

Some Background

Before I begin my story, however, I must offer a disclaimer and let you know who I am and also what I am not. I am not a medical professional, physical, occupational, or therapist of any kind, a lawyer or paralegal, or a social/case worker. I have never been employed by a rehab facility, hospital, insurance company, or any organization dealing with skilled nursing rehab appeals. I have never been professionally affiliated with Medicare or Medicaid. I possess no certifications or formal education or training in any of these above areas.

However, what I can offer you is this: my perspective as an older woman who has been in three different skilled nursing facilities as a patient for varying lengths of time, and who at this point, has filed over 20 Medicare Advantage appeals on behalf of myself. Some of these appeals I won (thankfully!), and some I lost. I understand the frustration of being in a rehab facility and just wanting to get stronger instead of having to deal with the insurance companies. There were times that I was so upset that my tears would flow. Often I just wanted to shout at my insurance company, “Please just leave me alone and let me get healthier!”

My experience has been with Medicare Advantage appeals only. Once upon a time, I had a Medigap supplement plan that quickly became financially unaffordable for me. Then I switched to Medicare Advantage. While I had my supplement plan, I was not in the hospital nor in any rehab facilities. Some staff members at rehab facilities have told me that therapists have more “say-so” about which patients come and go and when they leave if the patient has a supplement policy rather than Medicare Advantage. I believe that is probably true. I am unable, however, to verify that through my personal experience.

I think that there are good people who work for the insurance companies. There also may be times when people are discharged from rehab when they are truly ready to leave and can go home safely. There are other times when people leave prematurely — either on their own or they are “booted out” by an insurance company that is unwilling to continue paying for treatment. Sometimes those patients don’t reach the rehab potential they could have, and some end up returning to hospitals and rehab facilities. If these people are lucky, they can have enough help at home to continue therapy and do well. Unfortunately, corporate greed is all too prevalent in our modern society, and the insurance company “boot out” is a result of that greed.

Now that you know who I am and what I am not, let’s begin my story.

After Surgery and My First Rehab Stay

For several years I have struggled with digestive issues — gastric reflux (GERD), gas, nausea, constipation, and loose stool. By August 2018, I was getting worse. I was having pain, nausea, and feeling miserable. My husband and mother convinced me to go to the hospital emergency room on a Sunday afternoon. Imagine my surprise when I was told by the hospital doctor that I was having an emergency hernia operation either that midnight or early the next morning. I chose midnight. I had an incarcerated hernia and was in danger of losing part of my intestines. This was the first hospitalization I had had since June of 2000. It was the very first time that I was evaluated for physical and occupational therapy while in a hospital. When these therapists who evaluated me recommended that I go to a skilled nursing rehab facility, I jumped at the opportunity. I knew I was in poor health, weak, and could use the help. So as my hospital stay drew to a close, I had a visit from the hospital case worker who gave me a short list of in-network rehab places from which to choose. I had no clue as to how to select a facility. Because my surgery had been emergency surgery, there had been no time for me or my husband to visit any rehab centers. At that time I didn’t have a smart phone. Fortunately I did have my Kindle tablet at the hospital so I started reading reviews on Google, Yelp, and other reviews on the World Wide Web. The case worker said the best place to look for reviews is on the official Medicare website, www.Medicare.gov. I quickly weeded out any that mentioned “roaches in the beds” or “the building falling down.” Fortunately most reviews were better than those. The case worker needed a quick decision, so I finally just selected one and hoped for the best. I was transferred to the facility via medical transport and admitted. I stayed for 2 weeks. I felt that I benefitted from the therapy, but also felt that I had learned what I needed to. At that time a hurricane/tropical storm was heading our way within a day or two, so I made the choice to return home with my husband. Thus ended my stay in the first rehab facility. There was no insurance appeal related to my stay in this center at all.

By the way, I am not mentioning any rehab center names in these pages. My purpose here is not to review the rehabs but rather recount some of the things I have learned about rehabs and appeals. When I leave reviews, I do so through other venues.

Rehab Following Infection (Second Stay)

My second rehab stay was in December 2019. I had been hospitalized for a urinary tract infection (UTI). I was shocked that a UTI could sap your strength to the point you could barely walk, but evidently it can and did. I was in the hospital again for a few days, had another physical and occupational therapy assessment, and was recommended to go to rehab. This time when the case worker brought me a list of facilities, there was one I hadn’t seen on that first list. The reviews gave high marks to their therapy department so I chose this new facility. I did well in my therapy there and stayed about 3 weeks. I ended up staying one day over when I had planned to leave, because the day I was supposed to go I wasn’t feeling well. The following day I felt better and I went home. I don’t recall filing an insurance appeal that time even though it was the insurance company who was cutting off my coverage. I had gained a lot of strength. Fighting an appeal at that point wasn’t a priority for me.

Breaking an Ankle and the Third Stay

The year 2020 proved to be a horrible one for many of us. With the Covid pandemic, it was a scary time to be in any nursing home. In my case, I broke my right ankle while going to the bathroom in my home on March 9. It was a bad break (3 bones). I spent almost a week in the hospital and was again recommended to go to a rehab center for physical and occupational therapy. My ankle surgery was delayed for a few days due to the orthopedic surgeon’s schedule. My orthopedic surgeon had told me I was non-weight bearing for 8 weeks. I could put no weight on the ankle during this time. This would prove to be a real issue as far as the insurance company was concerned. Following my release from the hospital, I was discharged to the same rehab facility where I had stayed in 2019. I knew the therapists were really good there. My therapists did their assessments and told me that I was not coordinated enough to use crutches (I really didn’t believe that I would be able to use them either). Both my physical and occupational therapists tried very diligently to help me learn to get up and stand on one leg. The problem was that both of my knees had osteoarthritis, and neither leg was strong. The reason I had fallen to begin with was that both my legs had collapsed underneath me. I literally didn’t have a good leg to stand on. Whenever I tried to stand on my left leg and minimize the weight going through to my right leg, I still felt weight going through. The following day after standing my right ankle would hurt — not badly but just enough to let me that I had put weight on it. After a while, my therapists began to accept that I would not be able to stand up on the one leg and hop or pivot. So we did leg and arm exercises and the arm bike until my orthopedic surgeon granted me partial weight bearing status. I finally got 50% partial weight bearing status the first week in May. Immediately my physical therapists started teaching me to stand again on both feet and to weight shift from side to side in preparation for walking.

During this rehab stay, I had earlier insurance appeals that I had won. By mid-May, the insurance company thought that I should leave. They incorrectly assumed that I was still non-weight-bearing at that point, and they were saying I was not making progress. They said they would not cover any days following May 18. On May 18, to the delight and relief of both my therapist and myself, I took my first 2 steps! It was a good start, but how could I go home on the 19th being able to walk only 2 steps? I wouldn’t have been able to go to the bathroom, kitchen, or even reach my bedroom door. It was untenable. Our home is a modular house. My wheelchair doesn’t fit through all the doorways. I had to be able to walk certain distances. So I asked my physical therapist how long it would take for me to be able to walk functional distances that would enable me to go home safely. He estimated that the time needed would be a month. I lost my 2nd level reconsideration insurance appeal concerning the May 19 discharge. Our best recourse then was to go private pay for a month. Then we would file a 3rd level appeal that would be heard by an Administrative Law Judge. So my husband paid privately for my room and board, Medicare Part B took care of the therapy costs, and I stayed the month. With my physical therapist beside me, I walked out of the rehab facility on June 19.

We began in earnest to prepare for the 3rd level appeal by doing Web research and getting as complete a record (both medical and therapy notes) as I could from the rehab center. I put together a 3-ring binder notebook, with plastic sheet covers, and dividers. I included sections for therapy notes and assessments, doctor office visit notes and other medical records, and financial information (so the judge would know what compensation we were seeking financially). I wrote an introductory letter to the Judge for the front of the book. There were two timelines included. The chronological one showed that my time at the rehab fell within the 100 days that Medicare can cover. A progress timeline demonstrated the progress that I made in that final month. I needed to prove that the insurance company’s paying for that additional month was justified.

In September we had the Administrative Law Judge (ALJ) hearing from Atlanta, Georgia, by telephone. Due to major mistakes (HIPAA violation, inaccurate statements) made by the insurance company and quality improvement organization, we won the appeal and were able to recoup the money that my husband had paid for room and board. The day of the hearing no one could argue the fact that I had been carried into the rehab facility on an ambulance stretcher and unable to walk and left the facility by walking out with a walker and my physical therapist. I even had a video of me walking out of the building.

The Fourth Stay and a Viral Syndrome

Following my broken ankle (third) rehab facility stay, things went very well for a while. I had home health care for several months, which is probably a bit unusual. I had had home health care years earlier, and it only lasted a few weeks. During this time, we had two CNAs whom we employed who helped me get bathed, dressed, and up on some days, those not covered by the home health bath aid and my husband. Then in March 2021 I became sick will an illness that my hospital doctor later said was probably some kind of “viral syndrome.” The end result of this syndrome was 5 to 6 days of intestinal distress. Enough said. I was admitted to the hospital, and stayed a few days. Although he ordered a culture, the doctor never did have conclusive information of what caused the illness. Again the hospital recommended me for physical and occupational therapy at a skilled facility and away I went back to my former stomping ground where I remained until April 9, 2021. At the end of this stay I had filed and actually won a 1st level insurance appeal so I could have stayed at the facility longer. My husband would owe some hefty copays though so I left to go home with home health care.

Regrettably, things never really worked out as well with home health care this time. During this time period I was experiencing a great deal of wheezing, which I thought had been leftover from my bout with bronchitis. I was also experiencing blood pressure spikes. These respiratory and blood pressure issues made me nervous about pushing myself hard with the walking. Even without the home health, however, I still managed to do well enough to have cataract surgery on both of my eyes in September 2021. Then came the night of January 25, 2022.

An Unexpected Stroke (Fifth and Sixth Stays)

On the afternoon of January 25, 2022, I went to my eye surgeon for an office visit so that he could “release” me following my cataract surgeries. Everything went well at the appointment, and my doctor gave me the prescription for my new eyeglasses.

After returning home that day, I was tired. I decided to go to bed earlier than usual. My husband brought me something to eat for supper in bed around 8 pm. I enjoyed the food and looked forward to an uneventful, restful night. I had been sleeping a little. Around midnight I touched my face with my hand. I didn’t understanding what had happened. My left hand, fingers, and part of my left forearm were numb. The left half of my face was also numb. Maybe it was “asleep” from my sleeping on it? There had been no pain, no headache, no dizziness, or nausea. What was this? I had no idea that I had suffered a stroke. Earlier in my life I sometimes had “spells” of dizziness plus tingling on the left side of my face and in my left hand. One doctor had diagnosed me with atypical migraines. Now I think that these spells may have been mini-strokes or TIAs, warning signs of strokes to come.

Since my left arm, hand, and face did not seem to be getting progressively worse, and my husband was sleep, I decided to wait until the morning to notify anyone. In hindsight this was a foolish move on my part, and I would now advise any one who suspects that they are having stroke symptoms to get help immediately.

When morning came, the CNA who helped me arrived. She cleaned me up, got me dressed, and up sitting in my chair. I called my primary care doctor’s office and was advised to go to the hospital emergency room right away. At this point my numbness was the same — no worse, no better. In my earlier dizzy spells the tingling and dizziness would subside usually after a few hours.

My husband drove me to a stand alone emergency room. The doctor there suspected “stroke,” but there was no MRI machine there to prove it. The people at the emergency room kept me overnight until a bed opened up in the hospital. I spent the next few days in the hospital where they performed a brain MRI and diagnosed me with an ischemic stroke. While in the hospital, I had another physical therapy evaluation. Therapy recommended that I go to a skilled nursing rehabilitation center.

At the time of my hospital discharge, my rehab facility of choice was not available due to its having an outbreak of Covid. Those I read more reviews, spoke with the hospital caseworker for her feedback, and selected a different facility. This was my third rehab facility.

As I mentioned above on this page, it is not my intent to review facilities here. That being said, this rehab stay was difficult. I entered the rehab center on February 1, 2022. That same week I suffered a torn meniscus injury in my right knee while I was doing physical therapy with my therapist. This injury caused me sharp, stabbing, excruciating pain and vastly complicated my therapy process. Even though I had to fight insurance appeals, I stayed in the facility until April 1, 2022.

On the prior evening, March 31, I was feeling dizzy. The left side of my face was still not back to normal following the stroke. Instead, it felt strangely “intense.” It is hard for me to articulate exactly what it felt like. When I didn’t feel better the following day, I decided to go by ambulance back to the hospital.

The last week in March, both my therapists at the rehab center told me they thought that I was strong enough to go home. I didn’t feel that was the case. My walking was inconsistent. Some days I walked a considerable distance (80 to 90 feet), which would aggravate my right knee, and the following day I had trouble walking even 10 or 15 feet. It became a cycle of injury, healing, re-injury, and knee pain. Right after my therapists told me that they thought I could leave, the insurance company issued another notice that they were going to terminate my coverage. I was under insurance appeal when I left the facility for the hospital. While I was still in the hospital, I was notified by phone that my insurance appeal had been denied.

I spent 6 days in the hospital in the “neuro” wing. I was evaluated for stroke. Fortunately I hadn’t had an additional stroke nor any TIAs. While I was in the hospital, I convinced the doctor to do an MRI on my right knee. Although x-rays and CT scans had been done previously, no one had performed an MRI. The MRI test is what finally showed the torn meniscus. Now I had the answer as to why this pain was so much worse than my more usual achy, stiff joint arthritic pain. Before I had the MRI, some nurses told me that I had “just arthritis.” In reality, there is no “just” to it. A case of severe arthritis can be debilitating. I had osteoarthritis in both knees and a torn meniscus in the right one.

When it came time for me to leave the hospital, I was again given the opportunity to go back to a rehab facility. Since I knew that the therapists at this last place thought I should go home, I chose not to go back there. To my delight my rehab of choice was again accepting patients. If my insurance approved the stay, I could go back there. I went back to my preferred facility on April 6, 2022. My therapists worked very carefully with my knee, and I grew stronger. I was able to walk longer distances with little to no distress. I remained there until May 17, 2022.

My Most Recent Stay (Seventh Stay)

When I came from the rehab facility in May, I intended to go to an outpatient therapy clinic for my physical and occupational therapy. I figured that outpatient therapy would be more intensive than the less frequent home therapy and that the clinic could offer equipment that home therapy could not provide. I didn’t even request home therapy from either the rehab facility or from my doctor. Outpatient seemed a better intermediary step for me. If need be, I could sign up for home health care later on. What I didn’t figure on was that I would have have difficulty getting to the clinic. My transportation to outpatient therapy never worked out. What I should have done then was to request home health care, but I never did. At that time my sole caregiver was my husband. I fully convinced myself and that he and I could go it alone. Instead my physical condition declined.

One November 7 of this year, I re-injured my right knee. I was walking into our bathroom, which is a tight space with very little room for turns and pivots with a walker. I likely slightly twisted my knee. After I went to bed, I put ice on it. The ice made it less painful for a while, and then it started hurting again. The pain wasn’t that intense but it was uncomfortable. In an attempt to get my leg “easy” I rolled the opposite way in my bed. I didn’t realize it but I was very close to the edge of the bed. When I rolled over, I landed in a kneeling position on the floor next to the bed. Landing on arthritic knees did not feel good. I managed to get off my knees onto my side. I was still crouched on the floor in a very tight space. At first my husband could not hear me calling for him. After an hour or so, he discovered me there and summoned an ambulance. When the rescue squad arrived and asked me I wanted to be transported to the hospital, I said “yes.”

The doctor at the hospital ordered x-rays of my knees, an MRI of my brain, and some other tests. I stayed on the “neuro” wing again. I told the doctor about my stroke symptoms which to this day continue to get better, get worse, get better, get worse. The numbness is finally subsiding, but in its place are prickly, pens-and-needles feelings. I was worried since these feelings fluctuate that they could be symptomatic of another stroke or TIAs. The doctor assured me that the MRI did not show any evidence of another stroke or TIAs. My hospital doctor recommended that I go for rehab therapy and filled out the necessary form.

This time though the hospital caseworker and doctor told me that the rehab facility I wanted to go to had no openings and wouldn’t have any for the “forseeable future.” I had to make a choice: would I choose a facility with mediocre to poor reviews and take my chances, or should I go home and hope that I could still get into the other facility? My form would be valid for 30 days. I had caught some kind of respiratory “bug” (not Covid or the flu) in the hospital. I wasn’t feeling that well anyway so I opted to go home.

The very next day a woman from the admissions department at my favorite facility called. They had an opening coming available. Now she would need to see if my insurance would pay for the rehab. My insurance agreed to pay. I left for the facility on November 16 and returned home on last Saturday, December 17. During this time, I re-injured my right knee, which definitely impacted my physical therapy. However, at the time that I left, I was again making progress and had begun to crawl out of the “hole” left by my injury. During my final day of physical therapy, I walked 77 feet, my longest distance for this rehab stay. I plan to file a level 3 appeal.

EDIT for UPDATE: My husband and I filed a 3rd level appeal. We had the hearing before the Administrative Law Judge on April 13, 2023. The Judge decided in our favor. This means that the insurance company will now pay for the last week in rehab that my husband and I paid for privately.

If you would like to know more about this rehab experience (November 16 to December 17, 2022), please go to this blog post.

EDIT for NEW UPDATE: For my most recent rehab facility stay (September 4 to October 13, 2024), please see my blog post for April 7, 2025.

I hope that you have enjoyed reading my rehab story and that it proves beneficial for you. Blessings!

Marcia Hart