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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Summary

Before being discharged from a hospital

  • Do not wait until the day of discharge to start planning.  
  • Meet with the hospital discharge planner as soon as you can and get a discharge plan. The plan should include everything you'll need to know for life after the hospital.
    • Every hospital has a discharge planner. The person may be a social worker or a nurse or an administrator.
    • A hospital discharge planner's job is to advise and consult with you about what is necessary for you to be discharged. Some of the services a discharge planner can provide are:
      • Help assure that you have a safe environment to return to when you're released from the hospital.
      • Help get you a post-hospital care plan.
      • Help make follow-up appointments with your doctor, including transportation to and from the doctor if necessary.
      • Help you understand the medications the doctor wants you to take, and how to obtain them. A planner can also help you learn about potential drug side effects and what to do if they occur.
      • Help you learn what continuing symptoms to expect - and which ones should trigger a call to your doctor.
      • Make sure you have a discharge release from the business office. (If you leave a hospital without the discharge release, it is likely the insurer won't pay for any part of your stay).
    • For information about what should be included in a discharge plan, click here.
    • If upon discharge, you will not require further professional medical services, and you have family or friends staying with you, a discharge meeting with your doctor may be sufficient.  Ask your doctor. If you do not need a discharge planner, be sure your doctor explains what your treatment plan will be at home, what symptoms are okay and which should trigger a call to the doctor. Also set the next appointment with the doctor.   
    •  If you are elderly, live alone, are transferring to another medical facility, or require additional treatment/services such as physical therapy, hospice, or home nursing care, you should meet with the hospital discharge planner.  
  • Also get a copy of a discharge summary. It recaps what happened in the hospital. Take it to your next doctor's appointment. 
  • If you will need assistive or medical devices: 
    • If you are going to require the use of a wheel chair, walking aid, or other medical device, ask for a demonstration/lesson while in the hospital.  Make certain that you feel comfortable using the device before going home.
    • Keep in mind that many of these items can be rented if they are only going to be used for a short period of time. 
    • If money is a problem, the discharge planner should be able to help you find free sources for these devices. 
    • Most hospitals have a physical therapist on staff that will come to your room if you need therapy in hospital or at home. If you think you need a physical therapist and your doctor hasn't ordered one, ask your nurse to speak with a doctor to arrange for one.
    • Find out if your caregivers need any special training to care for you after your discharge. 
  • It is also advisable to request a copy of results of all tests performed while in the hospital. Ask how to get a copy of your medical records. These records will be useful in maintaining a history of your medical treatment. You are legally entitled to a copy of tests and your medical records. You may be charged a fee for the copy. To learn more about medical records, click here
  • If the hospital asks you to pay the bill before leaving: Some hospitals ask for payment or co-payment in advance before discharge. This is to reduce their bad-debt expenses. They also use "time-of service" collection, which means when the medical treatment is performed the patient is expected to pay.  
    • If you don't have insurance: Negotiate with the hospital regarding the cost of the medical procedure and your stay in the hospital. Demand that you be given you the price that they give to insurers, their "best" price. To discover Medicare reimbursement rates for a procedure in your area go to www.cms.hhs.gov/apps/pfslookup/step1.asp offsite link/ offsite link. To learn how to negotiate with a hospital, click here.
    • If you are insured and the hospital demands you pay your co-pay on the spot, call your insurance company for advice to see if this is their agreement with the hospital. You may not have a co-pay if medical procedures and treatments were performed in hospital. 
  • If you want to stay in the hospital, but the doctor thinks it is time for you to leave:
    • The length of your stay in the hospital depends on your doctor and insurance company. They determine when your condition is medically stable so that you can be discharged. If they want you to leave the hospital earlier than you think reasonable, you don't have to go quietly. 
    • Do not leave the hospital if you feel disoriented, faint or unsteady; have pain that is not controlled by drugs you take by mouth; you cannot go to the bathroom alone, have trouble urinating or moving your bowels, or you cannot keep food or drink down. 
    • To learn how to stay in a hospital if the doctor thinks it is time for your to leave, but you don't feel ready, click here
  • On the other hand, press firmly if you want to leave earlier than your doctor thinks advisable. Do not leave without medical consent. If you do, you may be stuck with the bill for your entire stay even if you have insurance.

Assume any belongings you bring home from a hospital are contaminated and should be washed before being used again. As you are aware, there are potentially deadly germs in our hospitals.

  • When you leave the hospital, assume any belongings you bring home are contaminated. 
  • Do not mix clothes you bring home with any other clothes. Wash them with bleach. Regular laundry detergents do not kill some of the most potent germs.
  • Wipe down with a cleaner containing bleach any photographs, art work or other items which were brought to the hospital to make your stay more comfortable.

NOTE: If there are follow-up problems, the best way to ensure that you are covered by insurance is to return to the same hospital.  For example, postoperative care is part of surgery and follow-up will likely be part of it.  Surgery may begin when you enter the operating room but it does not end when you leave.   

A Discharge Plan

Discuss the practical aspects of life after leaving the hospital (a discharge plan).

A checklist of topics to cover should include the following subjects. Feel free to add any additional questions or concerns: 

  • Where you will live and get care after discharge.
  • What you can do to help yourself get better.
  • Symptoms that might signal problems.
    • What to do about them if they occur
    • Who to call, at what phone number, and when. (If the symptom occurs in the middle of the night, call then?)
  • Review the medications you are taking. (It is helpful to create a List of Medications to keep with you at al times). 
    • Are there additional drugs to add to the list that you may require when you get home? 
    • Any drugs that should be eliminated? (If so, check with the doctor who prescribed them before eliminating any drug.)
    • Review potential drug side effects and what to do.
    • Consider how to obtain medications. (In addition to the normal sources, the hospital pharmacy may be less expensive than your regular source).
  • Ask to shown (and to show your caregiver) any tasks that require special skills like changing a bandage or giving a shot. Then show that you can do the task. Ask for a name and number to call if you get questions.
  • Consider how to obtain medications. (In addition to the normal sources, the hospital pharmacy may be less expensive than your regular source).
  • Request printed guidelines where available. 
  • Ask if you will need special medical equipment. If so, who will arrange for it? What number should you call if there is a problem with the medical equipment? What is the name of an alternative supplier in case you have a problem with the suggested supplier? (Keep in mind that if you do have a problem with a supplier, you are free to change suppliers).
  • Think about whether you are able to do each of the following activities. If not, how will you get help? (Home health aides are available if necessary. Whether to hire your own or use an agency becomes the next question. The Survivorship A to Z document in "To Learn More" helps.)
    • Bathing, dressing, using the bathroom, climbing stairs
    • Cooking, food shopping, house cleaning, paying bills
    • Going to doctors' appointments, picking up prescription drugs
  • Review your health insurance to determine what will be paid for, and what won't. Think about who is the best person to negotiate with the health insurer for you to get payment for the services you need that may not be covered.
  • Ask to speak with a social worker if you or your family are having difficulty coping with your health condition. (And see Survivorship A to Z information about coping with emotions. See "To Learn More.")
  • When you should have a first follow-up doctor's appointment. If transportation is difficult for you, ask about transportation. (Set the appointment before you leave the hospital).
  • For emergency contact name/phone number
  • For answers to any other questions you may have.

Discuss any home preparation that may be necessary during your recovery.  For example, you may wish to convert a downstairs room into your bedroom, get a shower chair, an elevated toilet seat, or move furniture and loose rugs.

Find out if you are likely to require additional physical therapy, home nursing care or additional treatments or services.  The hospital will need adequate time to assist with the arrangements.

Confirm with the discharge planner which services will be covered by your insurance. If some services are not covered, the discharge planner should be able to provide you with additional information and resources.    

To Learn More

A Discharge Summary

Before your leave the hospital, ask for a written copy of your discharge summary. The summary is prepared by your doctor or discharge planner and should include:

  • A summary of your care and treatment while in the hospital. 
  • Your diagnosis.
  • The plan you are supposed to follow at home.
  • Any future doctor's appointments or scheduled treatments.
  • A list of all medications you should be taking and for how long.
  • What to look for which indicates that you should call the doctor or go to an emergency room.

Ask your doctor to include a list of do's and don'ts. This may include such things as:

  • How much weight you can safely lift, and starting when.
  • What household chores you can and cannot do.
  • When you can begin to drive a car.
  • When you can return to work or resume your normal everyday activities.
  • When you can start to exercise.

NOTE: Be sure a copy of the Discharge Summary is given to your primary care doctor and to every doctor who is currently treating you. For safety, make you own copies and give a copy ot each doctor at your next visit.

If You Will Need Assistive Or Medical Devices After Discharge

If you are going to require the use of a wheel chair, walking aid, or other medical device, ask for a demonstration/lesson while in the hospital.  Make certain that you feel comfortable using the device before going home.  Keep in mind that many of these items can be rented if they are only going to be used for a short period of time. If money is a problem, the discharge planner should be able to help you find free sources for these devices. 

Most hospitals have a physical therapist on staff that will come to your room if you need therapy in hospital or at home. If you think you need a physical therapist and your doctor hasn't ordered one, ask your nurse to speak with a doctor to arrange for one.

Find out if your caregivers need any special training to care for you after your discharge. 

How To Stay In A Hospital If The Doctor Thinks It Is Time For You To Leave, But You Don't Feel Ready

If the hospital attempts to discharge you before you feel you are ready, speak to your doctor. If your doctor is unable to extend your hospitalization, request a meeting with the discharge planner or patient advocate.  If necessary, contact your insurer and the hospital administrator. 

You probably should not go home if:

  • You feel faint or disoriented.
  • You are unable to keep down food or fluids.
  • You are unable to go to the bathroom unassisted.
  • Your pain can't be controlled with oral medication.

How To Stay If The Doctor Thinks It's Time For You To Leave

If you feel you are being asked to leave the hospital too soon, you have the right to appeal decisions made by your doctor, hospital or your managed care plan concerning:

  • If you feel you are being asked to leave the hospital too soon.
  • If you believe you have not been given adequate or appropriate plans for your medical care and other services you may need after you leave the hospital.
  • If needed services are not in place.

The law requires that you receive advance notice in writing telling you:

  • The date the physician and/or hospital plans to discharge you.
  • How to appeal if you wish to remain in the hospital.
  • A number to call with any problems related to leaving the hospital.

If You Have Medicare

If you feel that you are being asked to leave the hospital too soon and you have not received advance notice telling you when to leave the hospital, you should ask for your discharge notice (also called a Hospital Issued Notice of Non-coverage or HINN).  You must have this written discharge in order to appeal the physician's and hospital's decision about when you are to leave. Call the Medicare helpline at 800-Medicare.

If You Have Managed Care Type Health Insurance (such as an HMO)

If you are enrolled in an HMO or managed care plan, you have the right to an expedited review process if you feel your benefits are unfairly limited or denied, you are being asked to leave the hospital too soon, or that medically necessary services are inappropriately excluded from your coverage.  

Information To Help Argue For More Time In The Hospital 

If you need to request more time in the hospital, you may find it useful to know about a study reported in the Journal of the American College of Surgeons, that concluded  that speeding a patient's discharge from the hospital a day or two early in order to save money, results in little savings.

Researchers reviewed the total costs incurred by 12,365 patients who were discharged from the University of Michigan Health System in Ann Arbor. The study compared the costs incurred on a daily basis with how much money is saved by trimming the length of the hospital stay. The study concluded that cutting a full day off of the end of a hospital stay resulted in an average savings of only 3% or less.

What was the reason for such a minimal savings?  The study found that the most expensive days are incurred early in the hospital stay, when patients undergo expensive diagnostic testing and medical procedures.  The average charge for the last day of hospitalization was $400 to $450.  In comparison, the average cost of the total hospitalization was $17,734. 

To Learn More

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HMO's

If You Want To Leave A Hospital Before The Doctor Clears You To Leave

You can legally leave the hospital at any time against medical advice (AMA).  However, by leaving the hospital without the prior approval of your doctor, you may be putting your insurance coverage at risk. 

David Edward's doctor told him that that he could leave the hospital the following day.  Upon packing the next morning he was informed that his doctor had unexpectedly left town for the day, and had not formally authorized his discharge.  It was explained to him that by leaving the hospital, he, not the insurance company would be responsible for the hospital bill (totaling $15,000).  By creating a fuss, the hospital was finally able to reach the doctor and secure the discharge.