Follow
Share

Patient is in about stage 5 dementia, with a super pubic catheter and has to have medication given along with needing help showering & dressing. Doctor says needs 24-hr supervision.

Find Care & Housing
That was great! I read once that the person you get on the first call is not trained as they should be. They are reading out of a book. That you have the right to request their credentials if they turn down paying for something. Meaning, to make certain decisions concerning what is covered, they must be a nurse or a doctor.

You must be tenacious when itvcomes to Medicare Advantages.
Helpful Answer (1)
Reply to JoAnn29
Report

Wanted to give an update on respite stay in a memory care, paid privately upfront and submitted to Medicare Advantage plan to see if they would consider the claim. The plan denied the claim, stating room and board not covered. Called and spoke with representative and she gave advice on what to include in an appeal letter to the plan. Appeal sent and plan reimbursed the full amount of the respite stay, over $4900….was shocked and grateful that they accepted and paid on appeal. Sometimes it pays to be tenacious!!
Helpful Answer (2)
Reply to Bobbie61
Report
AlvaDeer Oct 14, 2024
Wow, Bobbie. Good work. I am shocked. I think your appeal did it! Proud of you and a great message to others to check in case their plan will really cover this.
(3)
Report
See 1 more reply
Bobbie61: Medicare does not pay for custodial care.
Helpful Answer (0)
Reply to Llamalover47
Report

As said by other readers, Medicare pays for medical care the doctor prescribes. Supervision is custodial care that Medicare does not pay for.
Helpful Answer (0)
Reply to Patathome01
Report

No, respite is private pay. The only time Medicare will pay for 5 consecutive days is if on Hospice to give family a break.
Helpful Answer (2)
Reply to JoAnn29
Report

Usually Medicare only pays for things that are medical, not custodial. This is a question best suited for a Medicare rep. If the answer is "no", then what does it matter? Are you asked in order to know if the claim should be submitted in the first place? Call them.
Helpful Answer (3)
Reply to Geaton777
Report

Ask a Question
Subscribe to
Our Newsletter