I don't know about the legalities, may depend on state laws, but I can share my experience. (This is all very new to me so take what you need and leave the rest.)
I didn't receive any statements from the facility during my mom's time in rehab until the time came that she had to cover the copay out of pocket, and then that bill didn't come until months after the fact. However, I did receive statements from Medicare that showed what was paid. I also received statements from her private insurance since they paid the 20% copay for a short time when that kicked in. I remember being surprised that the daily room rate didn't cover any of the therapy. They were all separate charges, but were covered.
Now that she is private pay and in long-term care there, I get a monthly bill broken down as follows: 1 - Incidental charges for the previous month, ie and broken down - incontinence care $/day, TV $/month, laundry $/day - hairdresser $/month) - wound care $/month. 2 - Advance room charges for the following month.
I had to make some calls about a few of the incidental charges as some aren't very specific (ie, wound care).
I have not received anything about prescription charges though, and she's been there 7 months and has lots of scripts. I do receive a list of them at every care plan meeting though. No prices, just the dosage, when they were started/ended. They use a pharmaceutical company to take care of the meds and billing for that. As a matter of fact, that company called and left a message for me about my mom's "overdue" prescription bill. I called and informed them we had never received a bill, if they would send one, I'd be happy to pay it. They then asked about insurance, and I told them she had Medicare and gave them the name of her seondary insurance, told them they should contact the facility if they needed further info like policy numbers. This was at least 2 mos ago and I still haven't received anything, maybe they worked it out.
I can only surmise that they only send statements when they need me to send $ (ie, if Medicare/insurance doesn't cover the "ALLOWED" amount).
They may not have to but ask for it anyway, I found out they were ordering things he did not need and I had to pay for stuff he did not need. Also make sure they are taking out the right amount they are paying each month some of these people take out more then they are supposed to . I got over two thousand back when I checked and saw more then what was owed was taken out.
When my mother was in a nursing home in PA (she's now in OH), they included a charge for "incontinence care" of $15 each time. We challenged this, saying we're willing to pay for the diapers (sorry, I can't recall what term we chose as being more "PC" in another posting--please feel free to remind me!) but we thought changing them was simply a standard part of what they were supposed to do. They gave us a credit of about $800 (I think it was 2 months' worth). It certainly pays to ask questions and challenge them when necessary!
Not an anser but a question: My mother is in AL in Iowa, and, so far, has enough from multiple income streams (SS, pension, etc) to cover her care, but the post I see from cetude concerns me. How/where can I find out more about Medicare, Medicaid, and probate in Iowa?
My mother is private pay in a nursing home, and we get a statement/bill each month listing the basic room & board plus various medications and miscellaneous items. Anything provided by an outside agency typically is listed on a bill directly from that agency. Sometimes the nursing home, which has changed ownership or management, is slow to send the bill!
many states do not require it and Medicaid will try to recover costs with an Estate Recovery law. so they can run up a bill and you will never know until the loved one passes. One thing about the government -- and Medicaid..it's a very dirty, ugly business. Whatever ends up in probate, Medicaid can seize.
That's why you need to see an Eldercare Attorney who specializes in Medicaid preparation. Especially the house (if the elder owns a home) and keeping it out of probate after they pass. Do not use an ordinary quick deed--they will be seen as gifting and Medicaid will penalize.
Cetude - I view MERP & probate entirely differently. Probate has defined rules/timelines for filing, administration & distribution. Medicaid is unsecured debt which has to file a claim as any other debtor has to. How claims paid depend on your state laws. But usually there a pecking order. For example TX is Level of Claim by Class for probate and MERP is a Class 7 claim, so everthing that’s in Class 1-6 dealt with first.
To me, bigger issue for families who have parents who want to keep their home is more initial problems (not Estate Recovery) in they: - are not in synch / agreement on how to pay to keep it OR - have no interest in the home & perhaps.... in dealing with anything to do with elder much less old house - cannot afford home for unknown period of time.
Rocket - the United NH supplemental sounds really really awesome. If you don’t mind me asking... Does it have a premium that’s taken automatically from her SS - like what SS does with MediCARE - or does she / you have to pay this from her personal needs allowance? Or she’s has a retirement that it gets premium deducted from? Was she on a United MediCARE supplemental Plan prior to NH admit?
Did you find this on your own or did the NH or Medicaid caseworker tell you about it? We have United thru hubs employer and I’ve seen zero on anything on this type of supplemental in the raft of mailings and email from United. When hubs retires for real, we can do a 1 time only opt in for United retiree policy which pulls premium from his pension. But it’s somewhat pricey compared to most gap policies. Although I think will be what we do as gives us more across state lines options for MDs.
Bet you spilled your coffee when you opened that $12,500 mo. bill!!
Mom had been on an Aetna Supplemental plan, prior to her admittance to the NH, and I was getting conflicting advise on whether she needed to continue that extra coverage since she was now on Medicaid. The director of the NH told me to check into this UHC Nursing Home plan and gave me literature on it. An additional benefit is it provides an on-site Nurse Practitioner through Optum to the residents who enroll, which equates to probably 1 NP per 60 residents. (The NH continues to provide its own NP for those residents who don’t have UHC. ) I am very happy with the coverage, as Moms NP has an office right on her floor and I have her cell phone number. She can check on Mom at a moments notice and write scripts if needed. The cost is free to me/her...it actually costs $36/mo but as long as a plan is less than $40/mo, then her Medicaid pays for it, so it doesn’t come out of her personal needs account and I don’t get any bill. If dont know if this plan is unique to NY, but maybe other states have it too, but it is strictly for NH residents.
Mom is in NY, on Medicare/Medicaid (CMS) with United Healthcare Nursing Home supplemental. I get a monthly statement from CMS, and one from UHC detailing what each covered for prescription drugs, lab work, medical services. I get a monthly bill from the NH with her share of cost, but it’s not broken down, nor does it show what the total bill would be if she was private pay. (I only know the private pay cost is $12,500/mo, because I got a private pay letter in error last month). Nowhere on any statements have I seen how much PT sessions or other PT related items cost.
If it’s private pay, you usually get a monthly bill for room & board. But the medical / health care costs get billed by the vendors supplying the service. How those are billed should have been in the admissions contract done at the NH.
If they are on Medicaid, it’s going to be how your state requires medicaid to run. Between my mom & MIL we had 1/2 dz different facilities in 3 states and never saw a Medicaid bill or breakdown of what Medicaid paid for while they were alive. The Medicaid tally was sent out only after death within the estate recovery MERP paperwork.
Now any costs being paid by Medicare, CMS would send out a payment report within 2 weeks of any bills that CMS paid through Medicare. & within the CMS statement would be the possible copay due $ amount.
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I didn't receive any statements from the facility during my mom's time in rehab until the time came that she had to cover the copay out of pocket, and then that bill didn't come until months after the fact. However, I did receive statements from Medicare that showed what was paid. I also received statements from her private insurance since they paid the 20% copay for a short time when that kicked in. I remember being surprised that the daily room rate didn't cover any of the therapy. They were all separate charges, but were covered.
Now that she is private pay and in long-term care there, I get a monthly bill broken down as follows:
1 - Incidental charges for the previous month, ie and broken down - incontinence care $/day, TV $/month, laundry $/day - hairdresser $/month) - wound care $/month.
2 - Advance room charges for the following month.
I had to make some calls about a few of the incidental charges as some aren't very specific (ie, wound care).
I have not received anything about prescription charges though, and she's been there 7 months and has lots of scripts. I do receive a list of them at every care plan meeting though. No prices, just the dosage, when they were started/ended. They use a pharmaceutical company to take care of the meds and billing for that. As a matter of fact, that company called and left a message for me about my mom's "overdue" prescription bill. I called and informed them we had never received a bill, if they would send one, I'd be happy to pay it. They then asked about insurance, and I told them she had Medicare and gave them the name of her seondary insurance, told them they should contact the facility if they needed further info like policy numbers. This was at least 2 mos ago and I still haven't received anything, maybe they worked it out.
I can only surmise that they only send statements when they need me to send $ (ie, if Medicare/insurance doesn't cover the "ALLOWED" amount).
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That's why you need to see an Eldercare Attorney who specializes in Medicaid preparation. Especially the house (if the elder owns a home) and keeping it out of probate after they pass. Do not use an ordinary quick deed--they will be seen as gifting and Medicaid will penalize.
To me, bigger issue for families who have parents who want to keep their home is more initial problems (not Estate Recovery) in they:
- are not in synch / agreement on how to pay to keep it OR
- have no interest in the home & perhaps....
in dealing with anything to do with elder much less old house
- cannot afford home for unknown period of time.
Did you find this on your own or did the NH or Medicaid caseworker tell you about it? We have United thru hubs employer and I’ve seen zero on anything on this type of supplemental in the raft of mailings and email from United. When hubs retires for real, we can do a 1 time only opt in for United retiree policy which pulls premium from his pension. But it’s somewhat pricey compared to most gap policies. Although I think will be what we do as gives us more across state lines options for MDs.
Bet you spilled your coffee when you opened that $12,500 mo. bill!!
https://www.uhcprovider.com/en/health-plans-by-state/new-york-health-plans/ny-medicare-plans/ny-nursing-home-plans.html
My DH has UHC Supplemental F Plan, and although it’s pricy he pays $0 copays, which he loves to remind me about.
If they are on Medicaid, it’s going to be how your state requires medicaid to run. Between my mom & MIL we had 1/2 dz different facilities in 3 states and never saw a Medicaid bill or breakdown of what Medicaid paid for while they were alive. The Medicaid tally was sent out only after death within the estate recovery MERP paperwork.
Now any costs being paid by Medicare, CMS would send out a payment report within 2 weeks of any bills that CMS paid through Medicare. & within the CMS statement would be the possible copay due $ amount.