....January 3, 4:49 PM
	Jamaica vs. Oxford: Hospital Alleges Age Discrimination By Liz Skalka A recently-released study by Jamaica Hospital Medical Center revealed Oxford Health Insurance’s Medicare Advantage program routinely denied coverage for older patients for certain types of healthcare. The study, conducted over a 19-month period between Jan. 1, 2006 and Aug. 2, 2007, focused on coverage for specialized acute rehabilitation and traumatic brain injury services offered by the hospital. The data reveals out of the 58 Oxford-insured patients who were referred for these services, 46 were denied coverage –an 80 percent denial rate. The average age of patients authorized for these services was 49.9, according to the data. The average age of patients denied was 74.8. Had these patients been covered under a traditional Medicare plan, 100 percent would have been approved, said David Rosen, CEO of Jamaica Hospital Medical Center and its parent company, MediSys Health Network. Mary McElrath-Jones, a spokeswoman for United Health Care’s Oxford Health Insurance, said the allegations of age discrimination are false, and claimed the hospital was trying to compare commercial plans to Oxford’s Medicare Advantage plan. “We believe the charges made by David Rosen and Jamaica Hospital Medical Center are preposterous,” she said. “They are comparing coverage under two different types of insurance plans – commercial insurance versus Medicare. Under Medicare plans, CMS (The Centers for Medicare and Medicaid Services) set the guidelines, which we follow vigorously, regarding reimbursement for acute rehabilitation coverage.” She added sometimes, in the cases of acute rehabilitation, the most appropriate treatment “may not necessarily be in a hospital setting but instead may include other options such as a nursing home or home-based rehabilitative care.” Rosen said the impetus for the report came on the heels of a 77-year-old patient, Angela Dispenza, who was admitted to the hospital with a compression fracture of the spine and was denied coverage for the services recommended by doctors. “They were content just to pay for an ER visit,” Rosen said, “and this lady who couldn’t stand would have been sent home with one nurse visit per week and several hours a day for a home health aid.” The majority of Dispenza’s treatment was paid for by the hospital. The media attention generated from her story pushed Oxford to pay for eight days of her 40-day hospital stay, Rosen said. If an older patient is denied coverage for acute rehabilitation services, he said, they either have to go through Medicaid, pay out of pocket or forego treatment. In some instances in the past, the hospital has even paid for treatment. “They’re really just passing the buck to the next provider for a patient that really should not go home,” Rosen said. “For them to argue that patients would do better at home, what does that mean?” Rosen noted that these patients are getting sold false plans by Oxford. “If you’re over 70 you’re not getting acute rehabilitation,” he said. “If you look at the whole population over an extended period of time then the numbers really tell a story.”