Questions/To-do
- ✅ Apply for Medicaid long-term care (CLTC)
- In progress. See "Medicaid Long-term Care" below.
- NHC also has LTC (if they have a bed open) - maybe put her on the list if we get her in there.
- Will Mom have her own room at NHC?
- Exercises we can help with at post-acute:
- Towel under chin and hold it in place. 10 sec, 10 times
- Hard swallow
- ✅ Submit our three selection for sub-acute therapy facilities.
- What should her medication be after leaving the hospital?
- ✅ Will the sub-acute facility check vitals and provide medication?
- Yes.
- Can we stay overnight at the sub-acute facility?
- Will the sub-acute facility allow us to leave with Mom for a bit?
- Will the sub-acute facility allow outside therapy to come in and help?
UHC Approval Only 14 Days - How to Appeal
https://chatgpt.com/share/68fbed69-4664-800e-867d-45d5ec522295
Yes — you absolutely can and should appeal UnitedHealthcare’s (UHC’s) decision if you believe your mom still needs post-acute (rehab) care. These denials are common, and many families successfully get more days approved once they appeal with the right information. Here’s what to do, step by step:
🧾 1. Understand the denial letter
UHC is required to give you (and the facility) a Notice of Medicare Non-Coverage or Denial Letter.
This document will say why they’re ending coverage (for example, “no longer medically necessary,” or “patient has reached maximum potential”).
It also lists how and when to appeal — usually within 24–48 hours for rehab decisions.
Make sure to get a copy of this letter from the case manager, social worker, or facility administrator.
📞 2. File an Immediate Appeal
You can request an expedited (fast-track) appeal by calling the Quality Improvement Organization (QIO) listed in the letter.
For example, if she’s on Medicare Advantage through UHC, the QIO handles urgent appeals within 72 hours.
Tell them:
“I’m appealing the discharge decision because my mother still requires daily skilled therapy and nursing care. She cannot safely return home or care for herself.”
If she has commercial UHC insurance (not Medicare Advantage), you can still request a rapid reconsideration — call the number on the denial letter immediately and say you’re filing an appeal.
🩺 3. Get the care team to support the appeal
Ask the therapists, nurse, and physician at the facility to:
Write short statements explaining why your mom still needs daily skilled therapy,
Describe what progress she’s making, and
Emphasize why it’s unsafe to discharge her now (for example, she can’t transfer, dress, toilet, or eat independently).
It’s crucial that they include phrases like:
“Requires skilled therapy to prevent regression,”
“Continues to make measurable progress,” or
“Discharge at this point poses safety risks.”
These clinical notes are what UHC reviewers look at.
📄 4. Submit supporting evidence
When you appeal, include:
A brief personal letter (from you) summarizing her current condition,
Therapy notes and progress reports,
Any recent medical updates (for example, dizziness, blood pressure issues, or medication changes), and
Letters from staff (if possible).
You don’t need to be long-winded — just make it clear she can’t safely function without skilled help.
⏱️ 5. Keep her in the facility during appeal
If this is a Medicare Advantage plan, she can stay in the facility while the first-level appeal is pending — and UHC must continue paying until the QIO makes a decision.
Tell the discharge planner you’re appealing and want her to remain in care pending review.
🪜 6. If the first appeal is denied
You can go to the next level (reconsideration or independent review) — many families win on the second or third level.
It helps to have the treating physician’s letter updated at each stage.
💬 Example script when calling UHC
“I’m calling to appeal the decision to end coverage for my mother’s rehabilitation stay. She had a stroke, cannot move the right side of her body, and needs assistance with all activities of daily living. She still needs daily skilled therapy and nursing care to continue her recovery. I want to file an expedited appeal.”
If you tell me whether your mom’s plan is Medicare Advantage or a private/commercial UHC plan, I can tailor the steps and exact phone numbers for you — they’re slightly different.
Would you like me to help you draft the actual appeal letter to UHC, using her condition and situation?
Reasons for Appeal (stay in acute at hospital instead of new sub-acute facility)
Post-acute Application Results
- Angel Oak - no (but maybe with CLTC).
- We should apply for CLTC now, because it's just good to have.
- Pruitt - no Medicaid beds available
- Brightwater - no, Medicaid not accepted
- NHC - yes, next week, tentatively Tuesday (October 28)
- They are a Medicaid facility.
- CLTC application: apply online
- How much does a sub-acute facility cost if it was private pay?
- ChatGPT: $5,000 - $8,000
- Melissa: agrees with that.
- Assisted living is a lot cheaper than that, but she has to be able to stand and pivot
- still thousands per month
- CLTC could help
- Down the road: Anderson Oaks, Windswept, NHC also has LTC (if they have a bed open) - maybe put her on the list if we get her in there.
Medicaid Long-term Care
- Ask the hospital social worker or case manager to start a “Medicaid long-term care application.
- They often have specialists who help families file this.
- Be prepared to provide:
- Proof of income and assets (bank accounts, insurance, property, etc.)
- Medical documentation showing she needs daily care or rehab support.
vmiller@scthrive.org - Vanetta Miller is calling me at 16:00. The non-profit company is called SC Thrive.
Takes at least 45 days to get approved.
Ref # for application: SCT-LTC-2025-050227
It took an hour on the phone with Vanetta, but it's done.
Insurance
Here’s what’s probably going on:
UHC (UnitedHealthcare) is her primary insurer, likely through a Medicare Advantage plan (sometimes called Medicare Part C).
In that type of plan, UHC essentially replaces “original Medicare” for billing purposes — so Medicare coverage is provided through UnitedHealthcare.
That’s what your mom meant by “Medicare is covered by primary.” In other words, Medicare isn’t billed directly; UHC handles and pays claims under the Medicare rules.
So when a facility or hospital asks, you’d tell them:
“Her primary insurance is UnitedHealthcare Medicare Advantage.”
Then, if she also has Medicaid, that would be her secondary insurance, which can cover any copays, coinsurance, or costs not paid by UHC/Medicare.
Which Sub-acute Facility?
Oct 21, 13:30
I just had a wonderful conversation with Jenna Harris. She works here at the hospital. Her grandma is currently in one of the sub-acute facilities, and her mom is the director at another one. Her top three match the top three that ChatGPT recommended. I’m going to summarize here.
- NHC
- Jenna's grandma is there. Gets good care and the staff is caring.
- Myrtle Beach Manor
- Jenna's mom is the rehab director. Her mom says it's a good facility.
- This facility is close to Grand Strand.
- Angel Oak
- Heard some mixed reviews, but also some good things.
- Didn't like Litchfield
- NHC and MBM have different levels, go from sub-acute to assisted living
- Brightwater - absolutely NO
- Tidelands is not subacute so not an option
- Patient can refuse therapy and do it later if they want. No schedule.
- If patient starts refusing therapy overall, or doesn't get better, insurance will stop covering.
- There was an initial dip in recovery when Jenna's grandma went to NHC. So don't be alarmed if that happens. If you transfer and then the weekend happens, and you don't do much, there might be some slight regression, but that's temporary.
- Also, the reviews you see online don't separate the nursing part from the rehab part. So if you see some bad reviews, it could have nothing to do with the rehab part.
From ChatGPT
My top 3 to evaluate further
NHC Healthcare – Garden City — appears to be the strongest of the group on public data (CMS/chain pages show average/near-average quality and staffing for the area). Medicare
Angel Oak Nursing and Rehabilitation Center — shows up on Medicare listings and consumer review sites with generally better staffing/rehab focus than the lower-rated homes on your sheet. It’s worth calling for up-to-date therapy outcomes. Medicare+1
Myrtle Beach Manor — mixed history but generally rated around average (2–3 stars) and frequently recommended over the clearly low-rated options. It’s a reasonable choice as a top-three candidate.
Why I didn’t pick the others for the top 3
The Retreat / Brightwater and PruittHealth – Conway show below-average CMS/inspection signals (many sites list them as 1-star or with notable deficiencies). Medicare+1
Brunswick Health & Rehab (Ash, NC) has low overall/inspection ratings and some concerning flags in public datasets. I’d keep it as a backup only.
