The nursing home my Father has been in for 16 months now has not been submitting the hospital bills, incurred for the 2 times they have sent him to the hospital, to Medicare. They've just been giving him the bills and he just let them lay there and now that I am finally able to visit him (after the pandemic restrictions) he's handed them over to me. I don't know the first thing to do or who to talk to for resolution of these bills. I have his Medicare card and wondering if I send them to the address on the back of his card?
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I am confused here. Normally when someone enters a Hospital, goes to a Drs, etc those providers ask for proof of insurance. Medicare being the primary and you have a secondary.*1 The "Hospital" sends a bill to Medicare. Medicare pays 80% of what they feel is reasonable, then that info is sent to the secondary insurance which may pay the balance.*2 If there is a balance left that is Dads responsibility.
Now, if this Hospital bill does not show that Medicare and Dads primary were billed, then you call the Hospital not Medicare. You ask if they have Dads insurance on record, if not you give it to them so they can bill Medicare and the secondary. Once they have the info, you should have no problem if Dad goes to that Hospital again.
Medicare and secondaries send out statements, they are not bills. Medicare shows you what they paid. The secondary shows you what Medicare paid and what they paid and the balance that is what Dad is responsible for to the provider listed. The providers billing should match up to the balance on the secondaries statement.
As said the NH is not responsible for submitting bills from other providers to Medicare. They actually can't.
*1 Not sure how a Medicare Advantage works when it comes to
Providers billing them since they are contracted by Medicare.
*2 with mine and my Moms secondary, there was a "share" clause.
We paid half of the 20% that Medicare did not pay. So we
always had a balance owed the provider.
But I have a ?…. Are they actual bills - like from a specific hospital, MD, lab service - or is it rather a statement of benefits? Or both?
MediCARE sends out - either paper or online - regular statements of benefits to enrollees, whether at home or if they r in a NH. It goes to the address on file, unless somehow he allowed for online / email statements. Almost all in a NH (whether they are medicaid or private pay for room&board costs) are getting something done that MediCARE covers….. like a flu shot, the Covid vaxx, bimonthly MD exam, biweekly “gait training” from the PT or “use of function” work from the OT. So his name, DOB and MediCARE info are floating out there in the health care universe.
Id suggest you go online at CMS (centers for Medicare and Medicaid) to see if you can open an account to access your dads MediCARE summaries. Technically / legally he is supposed to do it, so perhaps gets his info together, take your iPad and sit w him at the NH and obstensibly he does it. Comprende?
Normally, if they leave the NH to go to the ER or end up getting admitted to the hospital, the hospital will have his basic insurance info. His name & DOB will match up for his account w MediCARE. Hospital do real time billing, so something has been filed to his Medicare over the last year ++. He may have a copay depending on what his secondary insurance is or isn’t. If he’s on Medicaid, it should zero out.
Look at the date of service & code on the benefit statements. Things tend to be filed several times b 4 they get paid and then get dropped off a statement. A service could appear from ages ago as well, this especially for ambulance transfer runs (these get filed but get declined so they submit with another code 2 see if it can pass muster, rinse & repeat stuff). MediCARE tends to be pretty strict on providers filing in a timely manner in order to get paid. It may be that Covid gave loads more flexibility in filing. That is something that could be mucho importante for those bills. If a provider did not file a bill at all within say the 120 window as per regulations of the insurer or MediCARE so they won’t pay AND instead they now try to bill you for the full amount THEN you can use this to establish that your dad is not responsible to pay as the provider is out of compliance with thier contract w the insurance co.
Whatever you do, do NOT, again DO NOT ever say or imply that you will pay his bills….. that you will assume responsibility for his financials. Being POA does not mean you are personally responsible 4 his debt. If any bills have gone to collections, those guys are ruthless.
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