In re Barrett

(SSA Office of Hearings & App. Oct. 30, 1998). ; Clearinghouse Number: 52339

Description

Leg Amputee Entitled to Medicare for Skilled Nursing Care

Abstract

The administrative law judge (ALJ) held that Medicare should cover the cost of the skilled nursing services that claimant received after losing her leg. Claimant, a 75-year-old woman with cardiovascular disease, was placed in a nursing home after her left leg was amputated. Two weeks later her physical and occupational therapy was ended on the recommendation of her therapists, and the insurer decertified claimant for Medicare coverage. Claimant remained in the nursing home for an additional two weeks and was later discharged to an adult family home. At the administrative hearing, the medical expert testified that claimant had very serious limitations during the coverage period in question. The medical expert opined that physical therapy was warranted for improved mobility and transfer functioning. After considering—as required by the Medicare regulations—the totality of claimant’s condition, the ALJ concluded that skilled services were necessary. The ALJ rejected the insurance provider’s argument that claimant’s condition following her discharge from the nursing home was not relevant; to the contrary, the need for physical therapy following discharge showed that she needed physical therapy while in the nursing home.

Additional Information

Attorney Information
Claimant represented by Amy L. Crewdson, Columbia Legal Services, 1006 Fifth Ave. SW, Olympia, WA 98502; 360.943.6260.
Docket Date
1998-10-30 00:00:00+00:00

Files

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