My advice will help you, but the rules prevent it: A healthcare access story

Sofia (the girlfriend/grandma ex-skier with the unbroken “broken hip”) was discharged to go home from the hospital, without an explanation of her pain or any resolution of it. (The hospital will, however, bill Medicare for her care. Thank you, Taxpayer, for paying it.)

At home, the physical therapist told Sofia that the right side of her pelvis had become displaced forward, and massaged and manipulated her hip, reducing the pain. The physical therapist told her that walking would help her heal, as long as it wasn’t painful to walk. But there was a catch: Medicare would only pay for the physical therapy if Sofia stayed at home for the three weeks of the therapy. If she left home, e.g., to walk, Medicare would not pay the bill, because, able to walk, she wouldn’t meet the Medicare criteria for physical therapy. So the only treatment that helped—the physical therapy—will not be reimbursed if she follows the healthcare provider’s advice—though the treatment that did not help—the hospital care—will be reimbursed.

Advice for patients in a Catch-22 like Sofia: Walk, and heal. If you see the Medicare police, walk faster.

Reader, Do you have a Catch-22 story about how the rules have prevented helpful treatment?