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On the Healthcare Front

Issue #15: May 2023

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when should you call kepro?

  • If you are not ready to be discharged from the hospital.
  • If your Medicare skilled services are ending too soon. Examples of skilled services include things like physical therapy and nursing services.
  • If you have a concern about the quality of care you received.
  • If you have a concern about your medical care that needs to be taken care of right away.

Click on the link below for the phone number for your state. These services are free for people who have Medicare. 

Kepro Telephone Numbers

 older americans month

may is older americans month

May is Older Americans Month. Find a new passion, go on an adventure, and push boundaries by not letting age define your limits.

Read more about Older Americans Month:

are you using all of your medicare benefits?

medicareDo you know about Medicare's Annual Wellness Visit?

Let’s take a look at a specific situation.

Dorothy stopped in at the pharmacy because she was having an issue with her stomach. She wasn’t sure about what over-the-counter medication would be best. She asked to speak to one of the pharmacists to ask some questions.

While they were talking, the pharmacist asked Dorothy when she saw her primary care physician last. Dorothy thought for a second and said that it had been a while. After all, why go to the doctor if you’re not sick?

The pharmacist told Dorothy about Medicare’s Yearly Wellness Visit.

It’s a yearly appointment with your primary care provider (also called a PCP) to create or update your prevention plan. This plan may help prevent illness based on your current health and risk factors. That way, you can put a plan in place for your healthy aging.

Read more:

Yearly Wellness Visit (covered by Medicare)

Preventive and Screening Services covered by Medicare

about kepro's free immediate advocacy service

healthy living

what is emtala?

your medicare benefits

getting help when a visit to the emergency room doesn't go as planned

A visit to the hospital emergency room wasn’t pleasant for Andre, but for a different reason than you may think.

If you have Medicare and have a concern about the health care (or related medical services) you had, you can do something about it. You can call Kepro and ask about Immediate Advocacy services. This process can be used to resolve an issue quickly.

Immediate Advocacy is a free service for people with Medicare. It is used to help people quickly resolve a problem about medical care or services. Immediate Advocacy often involves Kepro calling a healthcare provider or facility on behalf of the patient.

A visit to the hospital emergency room wasn’t pleasant for Andre, but for a different reason than you may think.

Andre went to the emergency department at the hospital with searing pain. After walking a long way to the treatment room, he asked for a wheelchair. He was told that none were available. He was finally given a lounger with wheels, but he had to switch to another chair once he was in the treatment room. He was so uncomfortable in the chair that he asked for another chair with more of a cushion, so his pain wasn’t made worse by the chair. He was told that nothing else was available.

While he was waiting to be seen, he finally decided to leave because he couldn’t take the pain any longer.

A friend had recently mentioned Kepro’s free Immediate Advocacy services.

Andre called Kepro with concerns about not being able to get treatment at the hospital emergency room. He complained and was told that these issues would not be available in the medical record (and therefore wouldn't be able to file a quality of care complaint). 

Instead, Kepro staff suggested Immediate Advocacy services could help with Andre's issue. Kepro’s Immediate Advocacy nurse was able to call an urgent care center a few blocks from Andre’s home. The facility staff said that they would take Andre’s insurance and stated that the waiting room was not busy at all.

Andre was greatly appreciative and said he was going to go to the urgent care as soon as he was done talking with Kepro staff.

learn more about immediate advocacy:

Read more on Kepro's web site: Immediate Advocacy

Listen to Kepro’s podcast episode about Immediate Advocacy - Episode 3: How Kepro's Immediate Advocacy Services Help People Who Have Medicare

read articles about hospital emergency room care for older adults:

Hospitals Remake Emergency Rooms for Older Patients

An Emergency Room Built Specially For Seniors

what is emtala? why should you care?

Medicare and You

The Emergency Medical Treatment and Labor Act (EMTALA) guarantees you access to emergency medical services at the emergency department. It doesn’t matter if you have insurance or are able to pay for the visit.

EMTALA is a United States Congressional Act passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986.

Read more about EMTALA:

Know your rights (PDF)

Get the details about EMTALA

Publication No. RI146810-295-5/2023. This material was prepared by Kepro, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 

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