Case Management & Discharge Planning Services
Soon after your admission, a case management team will meet to discuss your progress and eventual transition back to home or to an alternative care facility. This team is composed of an RN Case Manager, Social Work (SW) Case Manager, your nurse and may also include a dietician, physical therapist, occupational therapist and chaplain. The RN or SW case manager can assist you with information and referral to community agencies, convalescent and nursing home care, home nursing care, and medical equipment. Additionally, if you or a family member need help to adjust to a particular medical condition, short term counseling services are available through the SW case manager.
The case management team, including your physician, monitors your hospital stay in order to provide optimal care delivered in the most efficient and cost-effective manner.
Insurance regulations and strict federal and state laws require continuous monitoring of your treatment and length of stay to ensure the level of care is appropriate. You can assist us by informing your physician, case manager and hospital's financial counselor of any insurance company restrictions.
Should your physician find it necessary for you to stay beyond the number of days approved by your insurance plan, we may be able to obtain an extension for you if your care requires a hospital setting. Your physician and physician advisor at your insurance company will make the determination of the necessity of a continued hospital stay. However, if at any time during your stay your care can be rendered in a non-hospital setting, your insurance company may discontinue coverage of hospital expenses. You and your attending physician will be notified of non-coverage of your continued stay. Should such a circumstance arise, we will work closely and promptly with you and your family to identify an alternative care setting.
We will also assist you and your attending physician in the appeal process. If the denial is upheld, you may be responsible for payment of the non-covered days. Denial of insurance benefits does not indicate you must leave the hospital. Care will continue to be provided at the level required for your medical condition.
Medical Clearance to Leave
Before you leave, your physician must write a discharge order on our chart. If you choose to leave the hospital without your doctor's orders, you will need to sign a "Leaving Against Medical Advice" form. This form says that you will not hold Shady Grove Adventist Hospital liable for complications that may develop from your decision.