Table 2:

Participants description of their understanding of insurance coverage and out-of-pocket cost for patients being discharged to SNFs

Theme	Quotations	Role
1. Lack of Clinician, Patient and Caregiver Understanding of Insurance Coverage and Out-of-Pocket Cost	A. I would say 85% to 90% of the time, they really, whatever we say, they [physicians] are on board with, unless there is an issue with coverage, like, a Medicaid patient or someone with no SNF benefits either needs to go home or to acute rehab, and so if there is an issue with that, with the insurance payment, those sorts of things, then it becomes more of a well you need to change your recommendation because that’s not an available option. But I would say 85 to 90% of the time, the medical teams are very receptive to the recommendations that we make.	Hospital Physical Therapist
	B. If the insurance don’t back me, it’s [SNF is] out of the question. If the insurance don’t back me, I might as well try to stay here and if the insurance insists that they can’t back me on this, I’d go home. I know they’ve got a time limit on everything, but they would give me to more time if I was in an injury, during that car crash, I cracked my back, I broke my back or whatever. I kind of understand what goes on, you know?... I don’t want another thing if the insurance company doesn’t back me. Who’s gonna pay for [NAME] bill?	Hospital patient
	C. “I also had to appeal, not only for an extended stay, but for extended visitations because you have to also have, not respite care, but CNA care is not paid for by Medicare after a certain period of time, and so, it would have been nice to know that all that was gonna happen cause I ended up paying $300 a day. For my mother the first time. $300 a day, not a week, not a month. $300 a day and having to go through the appeal process and work a regular job and raise my daughter as a single parent and try to keep up with whether my mother was gonna live or die.”	Hospital Caregiver
	D. “ I think, a lot of patients look at their benefit and they say oh, Medicare is gonna pay for 100 days of skilled treatment for me, but what they, and the same with Kaiser, Kaiser runs the bus and the insurance companies run the bus on these patients, so basically and you know, you have to make progress for insurance to pay for your stay and to continue to pay for you to receive physical therapy, occupational therapy and 24 hour nursing care, you have to be making progress, and a lot of the patients don’t understand that cause a lot of them, if they just plateau, they say well I have 100 days by my Medicare, and a lot of them don’t understand that process, so that’s also a lot of education and hand-holding on this end…”	SNF nurse
	E. “Oh, I don’t know. If my insurance runs out tomorrow, I don’t know what I’m gonna do.”	SNF Patient