Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?

So sorry for your loss. But wonderful you paid someone so helpful. In the end though, if he has no money the bill won't get paid. You cannot be held responsible unless you signed as the responsible party.

I am sorry for your loss.

Final update.

The rehab did bill me for the last 5 days he spent there at full price. It was less than I thought but I still don't think I should have to pay 100% of this. Called the insurance rep who had reached out to me before. She is incredible. She told the rehab to apply for a covid related extension. Said she will call when that happens and to not pay the bill I have. Gave me the names and number of the people she talked to. I have never worked with someone so helpful before.

My father passed from Covid on the 11th.

Believe it or not someone called me yesterday from his insurance company to give me her contact info in case I had any issues or questions. I explained the situation and she said that as long as the rehab center billed it as covid related it would be covered. The extra days he had to stay should be covered at 80% which I can live with. If I get a bill from them I am to call her first before doing anything. I hope I am not getting my hopes up that I found a competent person to work with on this.

So sorry you are going thru this but all facilities and gov't agencies are swimming in unknown waters right now. If you think the hospitals ran short of PPE equipment you can only begin to imagine the shortage in rehab facilities. Additionally, their staff members were also getting sick and calling out. With all able and available staff directed to the hospitals, it was almost impossible to get any type of medical staff to cover at nursing homes. In other words...... it was pretty ugly for the entire medical industry.
Medicare may not yet have made a definitive decision about how to handle this situation yet. My suggestion would be not to pay anything to the rehab facility until you see something from Medicare. His rent at the AL must be paid if there is a chance of him returning but you need to look at the reality of that. ALs don't provide a lot of service just "assistance". Can Dad live at this level of low care now?
Since Dad has had to stay in rehab for the extra days because of the pandemic, does he need (and can he participate in ) more rehab? If he does and can participate, charges will likely roll back under Medicare (traditional)'s 20/80 rule as he has only used 40 days of his 100 day time set. Good Luck

To update again. I received a call from hospital telling me they were looking at discharge process for my father to a LTC facility. They gave me a list of places to choose from that take his insurance for short term rehab but will provide long term care. But they haven't officially said for sure he has to go to LTC so I can't vacate his apartment at AL...so he continues to pay on that.

I am trying to find a place that he can 'afford' on private pay for a period of time. While all will take Medicaid, my father helped out grand kids with funds for college 3-4 years ago before he went to AL and anyone knew anything about Medicaid. So now we have that problem. I am sick with worry that his one and only nice gesture will come back and bite me in the butt.

The last thing in this world I ever wanted to see was my father in a nursing home, bedridden. But that looks like where we are headed. At this rate I will pass before he does.

It is a disgrace.  The facilities are trying to get immunity from liability (and in some states they have it) for elderly loved one getting Covaid.  So heads you lose, tails they win.

I am so surprised that even with dealing with people who do this for a living, no one seems to be able to give a clear answer as to what is covered and what isn't.

In the past I have spent hours on the phone with his insurance just getting more and more frustrated. I think things are settled and then find out they aren't.

I am appalled that the rehab facility will even consider charging us full price for days my father had to spend there because he caught the virus in their facility.

You don't even know where to look for answers because everyone I have dealt with in the past has given me bad info. I'm just going to wait until the hospital tells me what the ling term outlook is for my father then ask for one of their social workers to work on a solution that we can all live with.

Maybe you need to talk to a lawyer.

Ikdrymom: So sorry that he has signs of the virus (saw your update posted 3 hours ago) and that he had to go to the ER. So does he have Medicare Supplemental to pick up the balance that Medicare won't cover?

That facility should be able to answer that question now. Their billing/social workers should be fully aware of the Medicare rules in regard to Covid. You would not be responsible anyway. They can bill him, but if he doesn't have money to pay, let it go to collection. If they don't give you answers, call your Ombudsman's office. They'll get to the bottom of it.

Medicare allows for 100 days of skilled nursing care. The first 20 days are covered at 100 percent and days 21 through 100 at 80 percent Medicare 20 percent co insurance or private pay. Medicare defines a skilled need as physical therapy which skills for occupational or speech therapy, a new feeding tube, IV antibiotics, and certain specialized wound care. Keeping him for care due to the virus does not meet a skilled need. However, to be sure, I would contact Medicare for a review. I'm thinking that it may not be covered. From your statement, it sounds like the facility is responsible. I would speak to the administrator and then if you are not satisfied, go to the level above. I think that this is problematic because since he is positive that limits your options due to the risk of exposure to others.

Just a random thought: what do folks do who do NOT have family helping? These issues are overwhelming, even to the smartest of us caregivers.

I think it is time now to call both medicare and your supplemental insurance for him to check on coverage. The assisted living will still charge; just be certain, now that you are likely in for almost a month, that they are not charging his "care fee".

Like the others, I suggest asking the billing department at whatever facility he is using AND contacting Medicare to ask that simple question. BUT, since this was not his fault and this is a pandemic, exceptions are being made on things like this. Many exceptions. My GUESS is that Medicare will pay for this and they should under the circumstances. But just call them.

Not sure what is being done due to the covid crisis but ..since he was actually ready for discharge from rehab before the 20th day, at 100%, I would fight paying anything out of pocket. Just let them bill , if that’s what they try. In some places al had to take back their Pts whether covid positive or not so check out the directives in your area. Lastly, the insurance biz has not caught up with covid yet..I actually read a case where covid is not considered a diagnosis to get home oxygen therapy improved despite the push to keep all but the most critical sufferers at home.

In a similar situation with with my 100 year old dad. I found working with Medicare a very frustrating experience and one must be careful of what is said to the Medicare agent. Now, it is my understanding that if your dad had a condition where he needs to hospitalized, if he is in the hospital
for three days or more, his 100 days of Medicare coverage can kick in again. But how do you get your dad in the hospital is the question. Don’t think his current condition would qualify, however watch for other related conditions like pneumonia. A health insurance agent gave me about the best advice. When it’s time to enroll in new plans, apply for Medicare Advantage as mentioned in another response, he cannot be denied coverage. But I will
be watching for more answers as no one taught us anything about joe to navigate through all
this bureaucracy.

This is frightening. I expect this may happen to my mother. Her original facility "transferred" her sometime after we applied for Medicaid. With a 3 hour notice of the actual transfer, she resides quarantined in our least desired COVID ridden facility. We can't afford hospitalization either, so I expect many people are and will be going through bankruptcy. Sadly appreciate all this information.

Insurance only pays 100 percent for the first 20 days.
After that your dad will be responsible for 50 percent of the daily amount from days 21 to 100.

He is covered for 100 days, but only the first 20 days are covered at 100 percent.

I am going through this with my dad. Just got first bill for days not covered at 100 percent.
It adds up quick.

Even though he was approved for additional rehab past 20 days, in fact it was recommended by the facility, bills mounted up quickly because only a portion was covered.

Now with catching Covid while he was in rehab, you may have some recourse. Could he be moved to a hospital where he would be covered by insurance due to being a medical patient, not a rehab patient?

Might be the best course of action.

medicare pays up to 100 days per benefit period--talk to a social worker
https://www.elderlawanswers.com/medicares-limited-nursing-home-coverage-12131

You also might see if your father could qualify for Medically Needy/ Share of Cost.

Call your state’s SHIP or in Florida SHINE for any Medicare information.

From Medicare.gov:
State Health Insurance Assistance Programs (SHIPs)
SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. SHIPs can help you with things like:

Your Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance
Complaints and appeals
Joining or leaving a Medicare Advantage Plan (like an HMO or PPO), any other Medicare health plan, or Medicare Prescription Drug Plan (Part D)
Find contact information for your state's SHIP

Here is a resource you might try. I’ve never used them but I get an email that tells of how they have helped others with Medicare issues. Let us know if it is helpful for you.
https://www.medicarerights.org/medicare-watch/2020/05/12/what-you-need-to-know-about-coronavirus-and-medicare-coverage

First Medicare pays the first 20 days at 100%, 21 to 100 days only 50% . The 80% you quoted was what they pay towards Dr. visits, hospital stays etc. And 80% is based on what they consider reasonable. Supplimentals may pick up the 20% in my case they don't. So those 40 days only 20 of them was 100%. The other 20 50%.

Now I am not sure about this, but Dad has 60 days out of the 100 unused? Not sure if he would be entitled to 100% coverage but at least the 50%. I would call Medicare and run this by them. I guess since they couldn't readmit, Medicare will not cover those two days?

I have found by calling Medicare they have proved to be helpful. In one case I was being charged for what Medicare did not cover. My husband and I went through the local Health Dept. and told them our secondary insurance was a mirror policy of Medicare. They billed us. Medicare advised I call and write them back letting them know what Medicare's response was. Haven't heard from them in months. I would call and ask for a supervisor. I can't wrap my mind around the millions of seniors of being affected and I hope you can find a good resolution to your problem. I care but don't know answers.

You say "we cannot afford $500 a day". Your father may be billed but you aren't responsible for paying for your father's care. His money pays for his care.