Due to an oversight by both hospital staff and the rehab/nursing facility where my MIL was sent, we were apparently incorrectly told she was eligible for Medicare coverage of the rehab stay. No one at the hospital said the transfer to the SNF rehab would not be covered, and the rehab center said it would be covered. MIL was there nearly a month, and I was told several times that it was covered up until a certain date.
Then I get notice from Medicare that it was denied because she was officially admitted to the hospital on her second day rather than her first, meaning that while she had a 3-night hospital stay, only two of the nights counted toward the 3 nights needed for Medicare to cover the rehab/nursing stay. Medicare said I should see about getting the admit date changed.
In MUCH digging around and calls, everyone from the hospital to the surgeon to the rehab center at first told me, "What's the problem? She was admitted the 24th?" Then I tell them what Medicare said, and billing was the only one who looked again and said, “Well, went in on the 24th at the hospital and was admitted on the 25th.” I got an event record from medical records, who themselves couldn't see the problem, and noticed that MIL was listed as on "extended care" until the 25th, at which time it changed to "inpatient." The surgeon's office had even repeatedly told me the doctor admitted her on the 24th and she was inpatient. When I finally asked about how it said length of stay was 0 days on the 2nd day there (instead of 1 day), they finally say oh, we can't change that because it's the difference between being OR and Inpatient. After they had just told me she had been inpatient since day 1.
I think staff got confused everywhere. The discharge summary sent to rehab said at the top that she was admitted the 24th and discharged the 27th, then said (3 days) - as in 3 overnights, the discharge day didn't count. Then just under that, it again said, "Admit Date: 5/24" and discharge date of the 27th - BUT under that, it said "Length of Stay: 2 days." It should have said 3, and the rehab people should have noticed this and queried it with the hospital. They didn't. Also, way down in the paperwork, in one small, easy to overlook spot, it said Care Timeline, and that 5/25 was the admission date (not 5/24).
So, I'm still looking into options to dispute this, but I think we're screwed. I don't think there's a good way to hold these people accountable for their failure to address the inconsistencies (though of you know of one, please tell me!). A lawsuit would be costly and still might not pan out, as typically these places have wording in their intake forms that say you agree to pay even if insurance doesn't.
SO, I have heard in the past that people have managed to get medical bills reduced. I'm expecting this bill to be as much as $15K, but am not sure, since the part Medicare denied was for about a week, but I'm using that to determine what the other, yet unbilled part could be.
What's the best way to negotiate this down if we must? And if that fails, what's the best way to make payments? Several people have told me to just send $5 or $10 a month on this - do I just send that without talking to them first, or do I need to discuss it with someone there?
First, get copies of ALL of the relevant notes, billings, etc showing the dates and people involved. Then build your argument from there. You do not need an attorney (yet) as this is a fight you can handle and win yourself. But you need to be detailed, organized, have a logical argument, and, most of all, determined that these people are not going to screw you or your family. The hospital bears the most responsibility here although it would have been nice if the SNF would have noticed the lack of three days as an in-patient and informed you. The hospital can and should re-code the first day to show that your LO was admitted since that is what some of the hospital records show and re-submit it to Medicare. It would be a cold day in hell before I would agree to pay any amount. Under these circumstances. I would not be afraid to let them know that you would consider filing a report with state and federal consumer and Medicare authorities for elder financial abuse as well as to local media consumer reporters who might air this to highlight and expose financial abuse of seniors by medical facilities. Use a chronological summary of numbered paragraphs to lay out the facts of what happened- like a legal affidavit. Send it to the specific person at the hospital you are dealing with via certified Mail where you get a return receipt. Make sure you end the summary by requesting a meeting to discuss your information and situation with the hospital representative. Bring a witness with you - don’t go alone. Stay calm and factual and to the point and be sure that whoever you bring with you also understands that assertive is ok - aggressive is not.
I would only consider hiring an attorney if your persistent efforts to get the hospital’s attention and action using all of the above fails. If you do go for an attorney - you want a fighter who either has experience or who has the drive to learn the Medicare rules and spend time looking at the details of how your LO’s hospital stay turned into this nightmare. Good luck. Don’t give in - you can do this!
One day I was feeling poorly and went to the ER. As it was quite late (1 A.M.), they were going to send me home. However, I advocated for myself and asked if I could stay overnight in the hospital (not the ER) for 'observation' as I was still not feeling well. It was covered 100% as a Medicare override. This is a little off topic, but it may help you Idk.
If anyone goes to the hospital for an illness and isn’t sure whether he/she is an “inpatient” or an “outpatient”, he/she MUST ask the doctor. I have always made it my duty to ask the ER doctor this question. If you assume that you are an inpatient when you are not, you could potentially be stuck with this huge hospital bill. You can get more information about this at https://www.Medicare.gov or by calling 1-800-633-4227.
Several years ago I learned there are times you "think" you are admitted but the hospital "keeps" you for observation and this can even be for more than one day in the hallway of the ER until they have justification for an admission. Also you can "think" you are admitted when you go in for an outpatient procedure but aren't actually admitted until there is justification to keep you longer than the procedure. It sounds like this may be what happened.
As far as the observation, there is a Medicare form they are suppose to give you when the decision is made to keep you explaining insurance does not treat it as hospitalization and give you the option to stay or go home. I don't know of a form they have to give you when you are admitted after an outpatient procedure.
I know it doesn't help in this case, but for the future, everyone should insist on knowing if they are officially admitted yet or not and when. If never "admitted" hospitalization may be billed to Medicare Part B which means there could be a higher deductible/copay. If you feel you need to go to rehab, be sure you read the info they provide saying how to appeal if you are being discharged too early.
It is my understanding as well that as long as you make a "minimum" payment you can afford they have to accept it. Not a hospital but this happened to us when my husband got out of the Air Force and they sent us a bill a year later for moving fees we were not aware. He was in college on GI Bill and we paid almost nothing for several months.
I have not read every word of these articles, but you may find the insight you need for your situation on these two web pages:
Go to page 5 of this article....
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SNF3DayRule-MLN9730256.pdf
https://oig.hhs.gov/oas/reports/region5/51600043.asp
Wishing you all the best in moving forward with this big headache.
Look up Medical Billing Advocate in your area, CMS.GOV-Patient Advocacy Services, AARP for info, Medical Billing Advocates of America.
We have AZ Association Patient Advocate Services that assist with Billing Denials, Appeals etc. Hope this is a start for you. You don't need to do this ALONE! Have a Blessed Day! Lou
I know my faith is what helps me during these times of handling my sweet father-in-law and dealing with all his bills, care and appts. He lives alone with dementia and medical problems and refuses to go to a care facility. My husband, an only child, can't do it either to see him go in a home. He wont be logical about the matter. It has been stressful on our marriage for 4 yrs now. We work at home together all day. I've made my husband step up with his Dad's care to see he does need 24/7 care. Actually after 4 yrs of caring for Papa at his home and dealing with a son and his drug use for 13 yrs, I'm beyond frustration and stress. I'm leaving to visit a friend for a month to care for myself and regroup! Sounds like you could use a weekend or week away yourself. I will pray for you, husband and MIL that your situation will come to a resolution. Do look for a professional advocate to assist with this mess. Use your MIL'S money to do it. You can't handle this alone! There is light at the end of the tunnel! God Bless!
My mom recently got a $10k bill from rehab/snf for “her share.” We negotiated down a mere $1,000. I thought it should have been closer to half. A friend in the business told me I should have talked to her first. But that’s all I got off.
Once it is turned to collections, the facility will get only a portion of recovery, so there should be incentive to negotiate bf then.
I agree to wait a few months to be sure all the bills are in and you have a final total. You know how there are all these separate providers billing separately. Then negotiate your best deal. If MIL has limited assets, she can’t pay. If she does have assets, she can.
Separate issue:
Don’t make my mistake—when mom was admitted in a state of high stress from hospital discharge and admission papers were shoved in my face, I signed my name without “ as POA”. Right after I did it I thought, “That was not a good idea.” But her ins is great and usually no bills so I was not too worried. But I did realize I had signed personally.
And then came the bill.
I believe you can get a better deal than I did. But I am unsure how to achieve it. Maybe do some googling on negotiating medical bills down. (I did not think of that.)
Best of luck! (This country’s med industry is a heartless money machine.)
See: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SNF3DayRule-MLN9730256.pdf
This is Medicare's "3-day" rule, which, thanks to your post, we are all now cognizant of!
Medicare may look at the time she was admitted if this on the paperwork.
For example if she was admitted at 9pm on the 24 and discharged at 9am on the 27, that would be 2 days (since 3 days would not be until 9PM on the 27).
Again, good luck with this.
Breathe.
I want you to remember that YOU and DH are in charge here
You call the SW at the rehab, tell her that hubs is POA and you expect a copy of the paperwork to be faxed to you to tomorrow.
Is MIL on Medicaid? Is she flush with funds?
If the first, you have no worries. She's judgement proof.
If she she HAS assets, I would suggest ringing up the Elder Law attorney who did her paperwork and take advice. On HER dime.
Please stop feeling like this is an emergency. This is an ERROR. Someone else's error.
The hospital needs to re-code the stay.
"Medicare denied was for about a week" If that is true, why do you think u will owe 15k? How are u figuring this out?
I was a collector/accts receivable and years ago I had a customer who was only paying me $5 a week towards money owed. Its called paying in good faith and not much I could do about it. If my company had gone to court for the balance, a judge probably would have said "can't get money from a stone". Would not be worth the cost. But I think things have changed in that respect.
When you have all the info, I would negotiate for less money owed on the grounds that the facility made a mistake. If they had pre-determined with Medicare, they would have found out earlier that MIL should not be in rehab. Then you ask for a payment plan that Mom can afford. It was their mistake, not hers. If she can only afford $25 or $50 a month thats all she can afford. The mistake is not Moms, its the hospitals for discharging her to Rehab and Rehab for assuming the hospital was correct. Stand your ground, this mistake was not caused by Mom.
Just a thought, what was the date Medicare told Rehab of the denial. If she received a letter, the date should be the same as when Rehab was informed and I would think they get their notifications electronically. Lets say Mom went in on the 1st. The notice was dated the 14th and they had it in hand, you should have been told then that Mom had been denied. You then had the option of having her discharged and cutting ur losses. Your letter was mailed and that is usually not done right away. Do you see what I am trying to say. You may not owe for days past the date of notification. You should have been informed of a problem when it came to their attn.
Also, (can u tell things are just popping into my head) you can also say she does not have the money to pay for the bill and see where that goes, it is their error.
I had a friend who owed a hospital bill years ago. When it was found her insurance did not pay the whole bill and she needed to pay them monthly, they lowered the charges. It does not look good for receivables to be unpaid after 60 days. 90 days is bad. So the sooner they get their money, the better.
Hope I have helped and not confused you. Another thing, if you do set up a payment plan, they cannot send Mom to collections. Again, she is paying in good faith. There are laws that protect Mom.
This is HER bill. Let it go to collections.