Mom in a nursing home with dementia. Nursing home is tacking on extra $1k to mom's balance owing (even though she has a set monthly co-pay rate by Medicaid), based on a four-day hospital admission from the nursing home.
Mom entered nursing home in September 2018. First 100 days paid by Medicare. Applied for Medicaid in November. Medicaid finally approved in March 2019. While waiting for approval I continued to pay mom's BC/BC, along with a few other obligations. This left a $5K back balance to the NH.
After Medicaid approval, I cancelled her BC/BC (a very good policy that she carried for years). I began to pay the current rent immediately, along with a set payment of $40 towards the arrears. Even though the current rent is paid on time, there is a $49 late charge each month on the balance in arrears.
I have lowered the arrears balance to $3K. My sister wants to pay the arrears balance (in exchange for my signing my mom's co-op shares to her. I am my mom's legal guardian).
I called the nursing home business office to confirm the balance owing that my sister will pay. My records show a balance of $3300. Nursing home says $4400. The reason for this is, they state, is because my mom was hospitalized for four days in March. And because it was considered a "re-admit", there is another $1k added to her balance owing.
How can they add another $1K when the monthly rent determined by Medicaid has been established? This sounds like each time my mother goes to the hospital, I will be owing another chunk? And why would this be owed to the nursing home?
I'm not sure I have conveyed this circus dilemma as clearly as it should be, and hoping someone gets it and can ask me the right questions for clarification.
I got a call from the NH doc last week. He wanted to send mom to the hospital for workup because she was more confused, and nursing staff said she was hallucinating. I told him the nursing home charged her $1k the month before while her bed was empty for three days. He then said -- we'll do the workup here then....
Good thing, because she bounced back during my visits beginning an hour after that phone call over a three-day period. I think the issue is that when she doesn't get proper enough sleep, she get more confused more often. Got to keep up on this stuff -- reasons for this and that. When I gave the doctor my handwritten report of my observation over three days he said, "....good thing we didn't send her to the hospital..."
So in the future, no hospitalization unless there is a true emergency.
You need to contact the Medicaid caseworker. Mom cannot pay for something she cannot afford and you are not responsible. You shouldn't even be getting a bill. Mom contributes her SS and pension. Medicaid does the rest.
This is a billing error by the NH or its something Medicaid picks up. Whatever, its not ur responsibility. Once my Mom was on Medicaid, the NH became her payees and I never saw a bill.
Again, I didn't sign her income over in the beginning for a few reasons -- Medicaid pending -- what if -- for some reason -- Medicaid was not approved? I chose to to keep her BC/BS active in the interim. She would have been straight Medicare from the start. Her BC was a very good policy. I can already see that since her BC has been cancelled, her medical testing (it seems) is going down.
And what if -- I had decided to take her home with me after the initial 100 days of medicare. I wish that had happened because mom has gone downhill over the seven months in NH. Now it is too late in the game for her to come home with me, pretty sure but not 100% sure.
I became her LG three months after NH admission. It's a learning process. I can never accept to -- just do what they tell you -- even if I end up making a mistake.
Was there any prior notification of this charge?
If your moms Blues has this system, please send a letter to the NH clearly stating that BCBS will be suspended (as she is now on Medicaid) and that all providers need to be notified by the NH as it’s the NH who hires or contracts the various providers for the NH. It will be the outside vendors - like podiatrist, Mobile X-ray co - who are affected the most. They will not be happy when the clawback finally surfaces.
The 1K is for NH rent, they say, for the days her bed was empty during her 2-3 day hospital stay. And right now I'm thinking -- she went to the hospital on Wednesday afternoon around 2 pm. She came back to the NH on Saturday around 3 pm. Hmmm.
The hospital admission occurred at the same time Medicaid was approved. I was actually informed by the hospital admitting clerk that my mom had Medicaid. Oh, really? I had no idea that it had been approved. I received notice from Medicaid on 3/25 that she was approved, retro to November 2018. How did the hospital know mom had medicaid and I didn't? It must be that information came from NH to hospital when she was admitted on 3/19. Of course that's how the hospital knew! Notice came to me by mail during that 2-3 days of chaos in the hospital.
I have not actually actually been billed that amount from the NH yet. The only reason I know about it is because my sister wanted to pay the arrears balance (rent that I had not paid while Medicaid was pending). I am LG so NH wouldn't talk to my sister. I called NH to see what balance they had. It was 1K more than my calculated balance. I questioned that. Biller said, "Well, maybe there was an adjustment made from when she was in the hospital in March." Oh, really?, i thought. "Maybe" there was an adjustment? If you are the Business Office, why are you saying "maybe".
I went to my mailbox and there was the bill. That invoice was dated early May. Rent due by May 15th. I paid rent along with a small arrears payment on May 9. The hospitalization was afternoon March 19 through afternoon March 23. So on the May invoice, this "maybe" adjustment was not yet on the invoice. From March. I told the administrator at a meeting a week later that "your invoice and information today is vague and obscure." And he abruptly ended the meeting and walked out when I told him I may be contacting the local news station watch dog to figure this out. He said if I did do that, he would be reporting me to Adult Protective Services...
Since Medicaid was approved (mid-March, retro to mid-September 2018 when mom was dumped to NH by my sister after a hospital admission), I have paid the required rent set by Medicaid -- SS/pension, minus $60 my mom gets to keep. So right now I am current except for the amount I didn't pay while Medicaid was pending. So I don't argue the co-pay rent. The late fee for that amount is questionable.
Everything I pay now goes to the back balance, nothing is applied to current monthly rent. I told NH I would pay two separate checks each month -- one for the current month, the other for payment towards the balance accrued during Medicaid pending. That is for my own bookkeeping -- so I can see exactly what is going on, on paper, in front of me on my desk. "We don't do it that way. The whole amount you pay goes to the arrears balance", they said. My reply -- so, in other words, it's like I have a Sears revolving change. Late fee every month and late fee increases the balance every month. There will be a balance owing, forever."
Then of course there is that $1k they want mom to pay. Not touching that. Waiting for Medicaid call me back.
I will continue to write two checks until this is resolved.
In my state, when patients were waiting for Medicaid to kick in the NH just billed the state for the back payment. It seems they only care about the money if they charge you a late fee every month.
If it were me I would call the state and have them check out their billing policy.
The NH will have the 800 number to the state agency visible when you enter the billing along with the survey.
It sounds to me like there has been a miss-communication or something within the business office or perhaps Medicare/Medicaid but that shouldn't be costing your mom. Again some of this may vary a little state to state, Medicaid is run by each state and actual dates may come into play but once Medicaid has kicked in there shouldn't be any back bills left. That's the point they don't kick in until she meets the income and asset requirement, sometimes even back paying a little but she shouldn't have any funds available to pay back rent. Still if I'm understanding this correctly;
Mom entered NH under Medicaid rehab/hospital stay status in Sep. say Sep 1 for these purposes (100 days max) did she enter from a hospital stay that might have started the 100 days prior to entering rehab or another rehab prior to this? Also that 100 days I believe include a lifetime benefit, has mom had any hospital stays in the past that lasted more than 30 days?
She became a long term NH resident at the same facility after being considered a rehab patient when those 100 days ran out around Nov 29. Her BC/BS was paying the co-pay up until this point and may have still kicked in to cover a portion of the cost maybe in conjunction with a different part of Medicare but leaving her with an out of pocket co-pay.
Medicaid approved and kicked in March 1 so she had at least a partial if not full pay for 3 mos. In March she had a trip to and was admitted to another hospital for 4 days or was she a skilled nursing patient there at the same facility? I believe there has to be 30 days of not being a "skilled nursing" or admitted to the hospital patient before a new occurrence starts, otherwise it's considered part of the original admittance but it looks like that should have been met easily. Now it may be that she no longer had the BC/BS policy in effect for that March occurrence so NH is charging for that portion but Medicaid should have then covered it since you didn't drop BC/BS until she was being covered by Medicaid.
I would urge you to talk to a Medicare counselor and a Medicaid counselor before paying another dime out of pocket to the NH, you might even find you need to talk to BC/BS depending on what the other two say and then once armed with info from the payer representatives go back and talk to the NH. You obviously aren't trying to get away with anything or not pay a bill mom is responsible for, no one can accuse you of that and the facility you have chosen made the choice to accept all of these insurances and the rules or parameters that come along with that so you aren't trying to get away with anything by holding them to that.
I don't know anything about the co op shares or how they are considered and passed on but I agree with JoAnn29 you might want to do some investigating about where they fit in when Medicaid was looking at moms financial profile, the last thing you want to do is put your mom and sister in a worse position unintentionally.
Good luck, these insurance, coverage, financial details are rarely simple especially dealing with Medicare and take a lot of time and energy to work out, your mom and your sister are so lucky to have you taking care of these details, watching out for Mom.
I am mom's legal guardian. Period. No POA/DPOA or conservator. Yes, checks are written from her account. I chose not to assign her SS/pension. I thought that was a requirement until I went to SS to do that (after Medicaid approval), who told me -- no, you are not required to do that. You can make the payment directly. And request for assignment has to come from the NH, not you asking for that to happen. Well, thank you SS, and it was a pleasure doing business with you today!
Looking over paperwork, I found "the contract" that was mailed to me months ago. I never returned it signed. I was in the thick of things directly Mom-related at the time, for one thing, and second, I just did not understand the contract. Because I didn't understand it I pushed it aside and stuck with "Mom" as my priority. And booooyy, am I glad I never signed that paper because now I understand it, after the fact.
I'm going to print your response. And thank you again.
Another question would be how the NH is billing Mom. Once she is on Medicaid there should be no extra billings. She has no money and you are not responsible for the debt. I would ask her Medicaid caseworker about this. Also, putting late charges on a balance owed.