Mom is resident in NH. In Feb we switched from her CarePlus Humana to straight Medicare A & B and D- that I'm still having issues working out if it was done correctly. We are and have been waiting for Medicaid approval.
In February, Mom had to go to hospital for low hemo and found bleeding ulcers- so now there are bills coming to her. Do I just tell them we are Medicaid pending and indigent?
How does this work for continuing care?
What was the exact date in Feb that she / you filed to have her exit Care Plus and date of switching over to Original Medicare?
And
is she getting any $ back from CP & if so are they prorating it to the date of the filing or instead doing it back to the end of January?
The health insurers tend to have the contract end the last day of the month before if Medicaid is taking over mid month…. and if this is what is happened it will be an exasperating clusterF to dealwith. Don’t pay any bills just yet, really truly don’t!
CarePlus (CP) is a MediCARE Advantage Plan. How Advantage Plans work best is that all / every provider, labs, imaging, etc are done at a facility that is “in network” for your moms specific plan and each provider (MD, PA, PT etc) are all themselves “in network”. The Advantage Plans rarely have any in network affiliation with LTC facilities like NH, MC. Look at the bills carefully to see the date and status on the “In network” on each bill as that will determine the supposed copay on the bill.
AND
at the same time see if these all these same vendors also participate in Original Medicare and in State of FL Medicaid program.
Those that are in both categories will end up getting paid either by CP or the M&Ms (MediCARE & Medicaid). They may have to rebill and end up paid less if M&Ms.
BUT
Until mom gets a new # for both M&Ms, there is no way to rebill just yet. She will likely get unfriendly past due bills or threats to debt collectors but until she has both #s a rebill cannot happen.
Inevitably someone will not get paid.
If you want to personally take on the financial responsibility to pay your Moms bills that’s on you. If you decide to do this, the bill may NOT be the amount on the bills you have in hand right now. Those tend to be discounted to reflect the “in network” pricing of CP. So if CP ended, that discount went away and she (you) will get a new bill that can be full tilt private pay rate. Like the MD visit that was $234 but w in network $35 copay will skyrocket to $750. If they have you agreeing to be responsible, you’ll be personally hounded on all this $$$. Yeah no good deed goes unpunished, lol 😂 . Most who go onto LTC Medicaid let the all old debts default….. like CC debt, old health bills, mortgages, etc….. as they basically have zero $ to ever pay these, unless their family pays the bills.
I'm just letting those who sent her bills that she is medicaid pending for them to rebill when its completed.
It will retro to Jan 1 2022 as per my Elder Care/Attny.
I will not be taking financial responsiblities.
there most definitely will be lots of vendors very unhappy. Stay firm and make your mantra that they will have to rebill to the M&Ms.
if you want to be a nice DPOA and don’t mind spending maybe $100 or so and an afternoon, here’s my suggestion:
- make a list of all vendors owed (name address and her acct #). Forget the $amount, or dates of service, etc. not yiur problem
- once she gets both her Original Medicare and LTC Medicaid #’s, you do a short memo to each vendor as to her new health insurance status and that all bills will need to rebilled as appropriate to either M or M.
then
- you mail each one as certified mail and return registered receipt (the green post card) from the post office. Will run abt $8.00 for the duo.
That green card gets returned to you with a date and signature (written or stamped or can be blank) and it’s legal. Yep it’s a legal document to show that they became aware of the changes and on them to rebill.
On the green card, the return section you address it as: Jean Smith Jones, on line to c/o Amy Smith, DPOA, and your address (unless she still is keeping her home, then goes to her home).
- as they come in attach them to their bill & into a box or binder.
Voila! You’ve done your fiduciary duty to protect her financial interests and if anyone gets nasty or threatening they can pound sand. I’ve found that doing stuff like this helps free one up from fear of getting the mail or answering a call on a # your not quite sure about. Well worth the $8.00 per letter imo.
Will have all the bills send their requests for payments (hospital, drs) to medicaid.
You do realize that these providers have to except Medicare and Medicaid? If not, the balance is Moms debt not yours. Same thing, provider may right if off because Mom in a NH on SS cannot be sued. Its not even worth the effort knowing Mom has no money and you r not responsible for payment.
I can't remember how I did it but my nephew did have Doctor bills prior to Medicaid. I was able to get him reimbursed by Medicaid. Also, if there are balances, when Medicaid kicks in, give the providers that do except medicaid the info and let them try and see if they can be reimbursed.