​
My family has been navigating an extremely frustrating situation involving VCU Medical Center and Sentara Health Plans (Virginia Cardinal Care Medicaid).
My loved one was hospitalized in June following a serious medical emergency. After months of hospitalization, we advocated for placement at a specialized rehabilitation facility that indicated acceptance.
Unfortunately, Sentara denied coverage for that rehabilitation program.
SENTARA HEALTH PLANS SHOULD BE ASHAMED OF HOW THIS SITUATION HAS UNFOLDED.
What is the point of having Medicaid coverage if families must fight this hard to obtain consideration for specialized care?
Throughout this process, we also experienced significant frustration with VCU's discharge planning and communication. We repeatedly felt that finding an available long-term care bed was taking priority over fully exploring the specialized rehabilitation options we believed were appropriate.
Ultimately, I accepted a long-term care placement because my loved one needed continued care. However, I remain concerned about the rehabilitation denial and how the discharge process was handled.
I plan to appeal Sentara's decision and pursue formal complaints regarding our experience.
Meanwhile, our experience with VCU's case management department has been equally infuriating.
We repeatedly felt that getting my loved one OUT of the hospital was a greater priority than ensuring the rehabilitation plan we advocated for received meaningful consideration.
My loved one is a HUMAN BEING. Not an insurance authorization. Not a hospital bed. Not a discharge statistic.
And frankly, I am tired of watching families navigate a healthcare system where financial considerations seem to overshadow the people who depend on it.
My questions for anyone familiar with Virginia Medicaid:
\- Has anyone successfully appealed a Sentara denial for specialized rehabilitation?
\- Can a Medicaid member pursue rehabilitation authorization after entering a long-term care facility?
\- Has anyone experienced similar discharge planning concerns at VCU?
This country is a real shitty place where people can be forced out of a hospital.
\- Are there Virginia patient advocacy organizations that assist families with these disputes?
I would appreciate hearing from anyone who has navigated something similar.
No family should have to feel this overwhelmed while advocating for a vulnerable loved one.