“Medicare, doesn’t work that way”, stated the accounts manager. She went on to say that the bills have gone unanswered and they are about to send it to collections if we don’t pay up.
The Medicare/Secure Horizons Confusion
This was a crash course in Medicare and Private Insurance for me. Basically, Secure Horizons only covered my mom’s stay from Day 1-10. Day 11-100 was my mom’s responsibility. The bill: $100/day. $100/day at 30 days = $3000. My mom stayed about a month in-a-half. This is where the complexity of long term care comes into play. This is where people become destitute, because their funds are depleted due to nursing care costs. Normally, a patient doesn’t go past 100 days without doctor approval. If the doctor feels that they are in need of further care, the patient stays, but at their own cost. As you can imagine, many average middle-class people cannot afford the costs of nursing home care. Therefore, their own personal funds are used to pay for care, and they reach a point where they can qualify for Medicaid which covers the rest of the costs. Unfortunately, my mom and dad still had too much at that point. They still have too much money now to qualify, which is where the struggle is for us now.
The Responsible Party
When my mom was admitted to the skilled nursing center, she needed someone to sign for her because she has Dementia. Typically, this would have been my dad. But because he has his own issues with his stroke, he felt more comfortable having my sister sign. Unfortunately, this particular facility did not give us a thorough explanation on what was expected of the responsible party. They quickly went through each sheet and basically gave my sister the idea that her only role was to sign my mom in. They did not properly explain that they would hold her financially responsible. They also did not make it clear to us that we would be charged after Day 10. They gave the idea that the insurance would continue paying, as long as the doctor approved treatment.
When the Rules are Violated
Sometimes the nursing home will use scare tactics to generate a response from the patient’s family to settle an unpaid debt. As I told the accounts manager, I had no idea what went on with her correspondence with my sister. I did not know if she received any of the letters or phone calls. However, this woman went on to tell me that as she was reading through the documents, she noticed that my sister signed for my mom’s admission, but that I signed for all of her medication and therefore I was financially responsible. “Whoa, I don’t think so.” is what I said, “If you try to come after me I will take legal action”. This was before I went online searching for answers and then following up with a call to the San Diego Elder Law Advocacy Group.
According to the Nursing Reform Act of 1987, under Federal law, a nursing home cannot require a co-signature of a financially responsible party guaranteeing payment to the nursing home as a mandatory condition for a resident’s admission. It is unfair and deceptive for a nursing home to assert or give the impression that it has the right to require a third-party co-signer for a nursing home resident’s charges.
The nursing home does not have to admit the patient if they cannot show how they are going to pay, but it cannot make the family pay. A nursing home may legally discharge a resident for non-payment, after required notice. Apparently, many nursing homes violate this law and use tactics to make the family pay. This makes sense. Why would we be personally liable, when we are not the patient? Right? If you have access and control over your parent’s finances, then you can be held responsible BUT with their money, not yours. You can read more about Nursing Home Issues at Alabama’s Legal Counsel for the Elderly.
Be Cautious
Lesson learned for us. Before you allow your parent or any loved one to enter a facility, be sure to get the facts straight with them. Make sure you understand clearly, what you are signing. You do not have to place your loved one there. I explained to the accounts manager that had we known about the insurance coverage, we would have immediately removed my mom from their care after Day 10.
So, as you can see, another headache, another stressful day. The skilled nursing center wants to make payment arrangements. With my parents’ $6000+ expenses in housing, food and caregiver, they can’t really afford anything. Therefore, it looks like my sister and I will be on this little adventure for a little while. I just sent out a letter stating my case to the nursing home. We’ll see what their response is, and I’ll be posting a new article.
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