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.
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.
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.
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.
Was there any prior notification of this charge?
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.
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.