Improvement Standard Stories

Selected Stories about the Use of the Illegal Improvement Standard to Deny Medicare Cooverage

Edith Masterman: Fighting to Keep Medicare Services

M.A., Missouri - "Not improving fast enough"

My mother was living at home and was able to get around with a walker. After a fall she spent 4 days in the hospital with an elbow infection. She was sent to a rehabilitation facility for the standard 100 day rehab. After about 30 days they kicked her off Medicare, stopped physical therapy and her status was changed to self pay. We found out about a week after this happened when they called about the self pay bill. I asked and was told that the reason for the Medicare denial was that she was making progress just not fast enough to qualify for medicare reimbursement. Now she just sits in a wheel chair.

D.S., Florida - From paralyzed to learning to Move... but that's not enough.

Optimum managed plan insurance has stated that “after 11 days of extensive physical and occupational therapy, you have not made any significant progress” so therefore have given my father 2 days notice of discharge or discontinued pay at his current skilled nursing facility. My father has made slow progress since working with his therapists, but they are saying it’s not to their standards after 11 days. My father was hospitalized for 3 months, being paralyzed, sedated, and in bed had lost all ability to move, or breath on his own. Finally able to breath on his own, he is on the mend, learning to move on his own and ready to get back to his healthy, active life but has been denied care after just 11 days in rehabilitation.