Unexpected crisis rarely comes at an opportune time. Severe injury can occur unexpectedly, leaving an individual with a long road of recovery and rehabilitation. During this stressful period, securing the necessary care and coverage is critical but often extremely complex and costly, particularly if multiple things “go wrong” at once. Having an expert consultant to advocate on your behalf, moving the various pieces of this process into place, can provide immense peace of mind and prevent significant expense to the trust during a vulnerable period.
An individual named Rachel was referred to National Care Advisors in March 2026 for a Special Needs Assessment. After an unexpected fall in May caused spinal injury necessitating surgical intervention and rehabilitation, NCA was called in for additional case management services. Rachel had originally suffered a severe spinal cord injury in 1992 that left her with incomplete quadriplegia. To make matters more complex, Rachel had lost all government benefits including SSI, SSDI, Medicaid and Medicare in January of 2026, after the death of her mother. This lapse in benefits left all medical related expenses to fall on her trust.
In May, post-surgery, Rachel’s trust received an out-of-pocket Good Faith estimate for 22 days of in-patient rehab—$49,000, with the referral expected to be 56 days. Since Rachel no longer had insurance due to the lapse in her benefits, the facility was attempting to discharge her home. Because of this, intervention and reinstatement of government benefits was of the utmost importance for her health and safety.
Assigned NCA Nurse Consultant, Mel immediately sprang into action, advocating with the facility for more time to research safe options. She coordinated with a local non-profit to reinstate Rachel’s SSDI and Medicare at no cost to the trust. In the meantime, Mel researched discharge options and secured a “swing bed” for Rachel at no cost to the trust. Once reinstated, Medicare initially declined coverage for inpatient rehabilitation based on Rachel’s physical therapy notes, indicating that she was not deemed an appropriate candidate for the level of intensive therapy initially recommended by the surgeon. Mel ultimately secured Rachel placement at a skilled rehab facility that was covered by Medicare and she was moved into the facility in June of 2026.
After a month of stay at the skilled rehab facility, Medicare denied further coverage in July, as Rachel had reached the maximum days covered by benefits. Mel began the process of reinstating Rachel’s SSI and Medicaid coverage and in the meantime advocated and coordinated with the facility to allow her to stay at no out-of-pocket cost until Medicaid was reinstated. Later that month, Rachel’s Medicaid was reinstated with a benefit payment issued retroactive to the date of losing benefits in January. This retroactive payment covered all hospital expenses, including the current facility stay, at 100%, conservatively saving the trust $124,727.
This case serves a powerful example of how nurse-led expert case management can not only ensure that a vulnerable patient is provided the best care possible, but that they are provided so without devastating financial consequences.
Contact us today to discuss how National Care Advisors can help you evaluate your unique circumstances and ensure you, your loved one, or client are receiving the benefits and services they are entitled to!