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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
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I'm no expert, but in NC, I was told by Social Services, several Assisted Living Facilities and two attorneys, that if the facility accepts Medicaid, then they have to accept what Medicaid pays them on behalf of the resident. The resident's monthly income goes towards the payment, except for $66.00 per month that the resident keeps for personal expenses. The rest of the the resident's income goes to the facility, but the facility must accept that as full payment and can't demand more.
I would check with the Medicaid assigned case worker.
Medicaid requires the resident to do a co-pay or their SOC (share of cost) of their monthly income to the facility less whatever small amount your state has as their personal needs allowance.
Medicaid should have sent whomever is on file as the contact person for the NH resident a letter of eligibility that states what the copay is. You kinda need to make sure this is accurate. For my mom, it was SS $ 800 and retirement 1K and personal needs allowance of $ 60. So every month, I paid from mom's bank account $ 1,740 to the NH as her Medicaid required SOC.
So is the facility getting the co-pay & have they gotten it for every month she has been in the facility? if not, it needs to be paid. If those funds were spent on other things by family, then family needs to make up the difference.
If you are good on the SOC, then it's a billing mistake….I'd send a note with the Medicaid eligibility letter to them and that should take care of it.
Do you mean they sent you a bill? As in you personally? Or was it sent to your mom? Or did someone ask you to sign something saying that you'd be responsible?
A couple of years ago, I came up with a policy that has kept me sane. Whenever a medical bill comes, if it's for more than my co-pay, I assume it's a mistake. Coming at these situations from that point of view makes for calmer conversations.
So, start out by clarifying in your mind who the bill is addressed to. Was your mother approved for Medicaid? Was she admitted as Medicaid pending? If so, I believe that the payment from Medicaid will be retroactive to her admission date. Talk to the business office and please let us know how you make out.
I thought the same as you. Have you discussed this with the billing office, or is there an ombudsman or similar agent that you could discuss this with? This does not seem right to me, unless there are other facts you haven't mentioned.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
I would check with the Medicaid assigned case worker.
Medicaid should have sent whomever is on file as the contact person for the NH resident a letter of eligibility that states what the copay is. You kinda need to make sure this is accurate. For my mom, it was SS $ 800 and retirement 1K and personal needs allowance of $ 60. So every month, I paid from mom's bank account $ 1,740 to the NH as her Medicaid required SOC.
So is the facility getting the co-pay & have they gotten it for every month she has been in the facility? if not, it needs to be paid. If those funds were spent on other things by family, then family needs to make up the difference.
If you are good on the SOC, then it's a billing mistake….I'd send a note with the Medicaid eligibility letter to them and that should take care of it.
A couple of years ago, I came up with a policy that has kept me sane. Whenever a medical bill comes, if it's for more than my co-pay, I assume it's a mistake. Coming at these situations from that point of view makes for calmer conversations.
So, start out by clarifying in your mind who the bill is addressed to. Was your mother approved for Medicaid? Was she admitted as Medicaid pending? If so, I believe that the payment from Medicaid will be retroactive to her admission date.
Talk to the business office and please let us know how you make out.