Someone's in the hospital or seriously ill
What should we ask the case manager?
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Ask three things: what is the plan for leaving, who has confirmed insurance covers it, and whom to call if it doesn't work at home. Ask early and get it in writing.
What to do
- Ask to meet the case manager in the first day or two, not on discharge day.
- Ask where they will go next (home, rehab or a skilled nursing facility) and on what date, and which places have already been sent their information.
- Ask who has checked that insurance covers it, and whether prior authorization (plan approval before care) is approved.
- Ask what is arranged, such as home health, equipment and follow-up visits, and for a number to call if the plan falls apart.
What to say
Can you walk me through the discharge plan, and tell me who has confirmed that insurance will cover it? I'd like that in writing before we leave.
Which facilities or home health agencies have you already sent my mother's information to? Which ones should I expect to call me?
Ask early in the stay. Hospitals often send a referral to several places at once to find an open bed, so calls can come before anyone has asked you. The list tells you who is calling, and the choice is still yours. A Friday discharge is hard to change over a weekend.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Meeting the case manager for the first time on discharge day. By then the plan is set and transport is booked, and there is no time to check coverage or choose a facility.
Better done together
We’re here to help
Case managers look after many patients at once, and the questions that matter most for your family don't always come up on their own.
We can help you prepare before the meeting: what to ask, what to get in writing, and what to check about your parent's coverage. The first time, we walk through it with you. After that, you'll know the questions by heart.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
Free · 15 minutes · No pressure
The rule behind it
Hospitals that take Medicare must run a discharge planning process that starts early in the stay and includes you and your caregivers. If you need a nursing facility, rehab facility or home health agency, the hospital must give you a list of those in your area and respect your choice. If you have a Medicare Advantage plan, the hospital should tell you which ones are in your plan's network.
Sources
- Cornell LII — 42 CFR 482.43, hospital discharge planning
- Medicare.gov — How do I choose a nursing home?
- Your written discharge plan
- Your plan's Evidence of Coverage
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
Start with the free Kit. If your situation needs a person, the intro call is free too.