Florida - Feeding Tube - Dr's threatening to stop insurance from paying.

[Saxidani]

What is the name of your state? Florida

My grandparents live in florida. My grandmother became ill, from an unknown illness and has been in a local hospital down there for seven weeks. All of her grandchildren and children live here in the northeast so we are all rotating traveling down to be with her.

She has a history of congestive heart failure and emphysema. However she has been relatively healthy considering. The doctors still have not figured out the cause of the illness that landed my grandmother into the hospital. She had serious edema in her legs and body, but the doctors insisted that it was not from the congestive heart failure.

The issue currently is this:

My grandmother is insured by Humana. The doctor that has been managing her care works for Humana in this hospital.

She has a feeding tube that is currently going down through her nose which they are using to assist in keeping her well nourished. She was having troubles with swallowing for a while after being admitted to the hospital.

My grandmother was eating apple sauce yesterday, drinking water, etc, but still has the nasal feeding tube to aid in nutrition. However the physician told my grandfather that they want to perform surgery to insert a feeding tube into her stomach so that they can send her to a nursing home. (They still have NOT diagnosed why she ended up in the hospital to begin with)

Our concern is that she CAN swallow foods, she can drink water, but the doctor wants to put her through surgery to insert a feeding tube, we don't see why it is medically necessary, since she is being nourished by the tube in her nose and by eating some stuff orally.

When we asked the physician what were the benefits of this feeding tube in weighing against the risks of it all the physician said was "well we cant put her in a nursing home unless she has a feeding tube in her stomach, they wont take her if it is in her nose."

What kind of answer is that????

So since the underlying illness still hasnt been figured out, and things are not being taken care of well at this hospital, (lots of stuff happening/ not happening) my family along with my grandmother don't want the stomach feeding tube inserted into her stomach.

This same physican said two weeks ago that any invasive procedure could be life threatening to her and was not advisable, now all of a sudden he wants to perform surgery and ship her to a nursing home.

Well my mom and my uncle and my grandfather talked about it, and came to the decision that the physican could not give us any reason how this particular procedure would benefit my grandmother.

This physician then called my grandparents other daughter and told her that she needed to call the family members and CONVINCE them to let the hospital do this procedure because if she ccouldnt convince the family to change their decision that he would call Humana and TELL THEM TO STOP PAYMENT/COVERAGE for my grandmother!!!!


I don't understand how a doctor can threaten to cancel my grandmothers health coverage because the family feels that the procedure is more risky than it would be beneficial to her.

Please, any help would be greatly appreciated. We don't know what to do, and we need help.

thank you in advance.

[ecmst12]

I think that what the doctor is basically saying is that it is no longer medically necessary to keep her in the hospital, she no longer needs that level of care, EXCEPT for the nasal tube. The decision on whether to continue to pay to keep her in the hospital rests with the insurance company themselves, not the doctor, but he can advise them that she does not require hospital-level care at this point and a nursing home would provide enough care, if they installed the other tube. But the ultimate decision is not his.

It may not be possible to diagnose the exact source of illness, in an older person with multiple health problems. If that's what you're waiting for, be prepared that you might never find out. Hospitals are for the care of acute illnesses, not the management of long-term, chronic health problems. If there is no definable acute illness that they can diagnose or treat in the hospital, then her insurance is paying a lot of money per day for more care then she needs.

I do think you should get a second opinion about how risky the feeding tube surgery is and how necessary. Find out how likely it is that she will be able to eat on her own without any tube, within a reasonable amount of time (or at all). If the answer to "what's wrong with her" is "she's old and sick but there's no one specific problem that we can treat to make her better," then a nursing home is probably the best place for her. You all need to take a realistic look at her options and prognosis before making any decisions.

[ellencee]

Originally Posted by Saxidani

What is the name of your state? Florida

My grandparents live in florida. My grandmother became ill, from an unknown illness and has been in a local hospital down there for seven weeks. All of her grandchildren and children live here in the northeast so we are all rotating traveling down to be with her.

She has a history of congestive heart failure and emphysema. However she has been relatively healthy considering. The doctors still have not figured out the cause of the illness that landed my grandmother into the hospital. She had serious edema in her legs and body, but the doctors insisted that it was not from the congestive heart failure.

The issue currently is this:

My grandmother is insured by Humana. The doctor that has been managing her care works for Humana in this hospital.

She has a feeding tube that is currently going down through her nose which they are using to assist in keeping her well nourished. She was having troubles with swallowing for a while after being admitted to the hospital.

My grandmother was eating apple sauce yesterday, drinking water, etc, but still has the nasal feeding tube to aid in nutrition. However the physician told my grandfather that they want to perform surgery to insert a feeding tube into her stomach so that they can send her to a nursing home. (They still have NOT diagnosed why she ended up in the hospital to begin with)

Our concern is that she CAN swallow foods, she can drink water, but the doctor wants to put her through surgery to insert a feeding tube, we don't see why it is medically necessary, since she is being nourished by the tube in her nose and by eating some stuff orally.

When we asked the physician what were the benefits of this feeding tube in weighing against the risks of it all the physician said was "well we cant put her in a nursing home unless she has a feeding tube in her stomach, they wont take her if it is in her nose."

What kind of answer is that????

So since the underlying illness still hasnt been figured out, and things are not being taken care of well at this hospital, (lots of stuff happening/ not happening) my family along with my grandmother don't want the stomach feeding tube inserted into her stomach.

This same physican said two weeks ago that any invasive procedure could be life threatening to her and was not advisable, now all of a sudden he wants to perform surgery and ship her to a nursing home.

Well my mom and my uncle and my grandfather talked about it, and came to the decision that the physican could not give us any reason how this particular procedure would benefit my grandmother.

This physician then called my grandparents other daughter and told her that she needed to call the family members and CONVINCE them to let the hospital do this procedure because if she ccouldnt convince the family to change their decision that he would call Humana and TELL THEM TO STOP PAYMENT/COVERAGE for my grandmother!!!!


I don't understand how a doctor can threaten to cancel my grandmothers health coverage because the family feels that the procedure is more risky than it would be beneficial to her.

Please, any help would be greatly appreciated. We don't know what to do, and we need help.

thank you in advance.

Apparently, there is no justification for continuing hospitalization and the physician cannot justify billing insurance and continuing hospitalization simply because the family has no single person designated to make decisions for grandmother.

The physician is correct that nursing homes are not taking patients with nasal feeding tubes. A PEG tube placement is a simple procedure and does not usually result in post-op discomfort. A PEG tube allows freedom of mobility when bolus feedings are used; and, I suggest that the family insist on bolus feedings vs. continuous feeding via a pump. Oral intake, what you describe as swallowing foods, should be encouraged and as soon as grandmother can take in an adequate amount of food and fluids, the PEG tube can be maintained with water flushes or discontinued and, or placed again later if needed.

Of course, I can't tell you what grandmother's diagnosis is but based on your information, I believe a diagnosis has been made and has been explained to the family and it is the family who declines to accept the diagnosis. Grandmother cannot swallow enough food and liquids to prevent starvation and dehydration. Low protein intake leads to generalized edema and dependent edema, thus the legs swell without there being a cause such as congestive heart failure. My opinion is the diagnosis is starvation r/t swallowing deficiency.

My advice is have the PEG tube placed, get grandmother out of the hospital before she gets a hospital-acquired infection, that one family member be made power of attorney or healthcare proxy and another family member be made alternate POA or healthcare proxy, and that grandmother be placed in a nursing home near those who can visit often. If granddad is alive, he should go with grandmother, if at all possible, or move near to her.

Grandmother may be on her way out of this life and the family needs to know that restoring her to independent living may not be an option now or ever. Your family's life has taken a turn and it is important that everyone gets on the reality train now rather than later.

I wish you and your family safe journey.

EC