Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?

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Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?

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Last month my father fell and went to the ER then on to rehab. It was work to find a rehab that would take anyone at this point. He stayed for 40 days which took him through 100% coverage and 80% coverage. AL required two negative Covid tests before re-admittance. His first test was on the 1st and it was negative. The first issue was rehab dropped the ball and did not retest him until the 16th for a 19th discharge date. Test results did not come back in time and they told me if he had to spend the weekend it would be at 100% self pay. At $500 a day I was not happy. Test results come in late on the 19th and they are positive. He has been moved to their covid wing but I haven't received a confirmation that his extended stay will be covered by Medicare. One person said it was covered and another wasn't sure. It is assumed he will be there for most of July and we cannot afford $500 a day especially when they are responsible for his exposure.

Has anyone else had experience with this? Is it covered?

Coronavirus Medicare Paying for Care Rehabilitation Center

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Here is a resource you might try. I’ve never used them but I get an email that tells of how they have helped others with Medicare issues. Let us know if it is helpful for you.
https://www.medicarerights.org/medicare-watch/2020/05/12/what-you-need-to-know-about-coronavirus-and-medicare-coverage

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I have found by calling Medicare they have proved to be helpful. In one case I was being charged for what Medicare did not cover. My husband and I went through the local Health Dept. and told them our secondary insurance was a mirror policy of Medicare. They billed us. Medicare advised I call and write them back letting them know what Medicare's response was. Haven't heard from them in months. I would call and ask for a supervisor. I can't wrap my mind around the millions of seniors of being affected and I hope you can find a good resolution to your problem. I care but don't know answers.

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Just a random thought: what do folks do who do NOT have family helping? These issues are overwhelming, even to the smartest of us caregivers.

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No family, the State becomes their guardian.

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You say "we cannot afford $500 a day". Your father may be billed but you aren't responsible for paying for your father's care. His money pays for his care.

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OK...he cannot afford. I am his financial POA and he has a budget that needs to be followed. While their is wiggle room, it is not up for taking a $10K hit. My concern is that he contracted Covid in their facility and now they expect him to be 100% self pay. I would think Covid should be covered by medicare.

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Insurance only pays 100 percent for the first 20 days.
After that your dad will be responsible for 50 percent of the daily amount from days 21 to 100.

He is covered for 100 days, but only the first 20 days are covered at 100 percent.

I am going through this with my dad. Just got first bill for days not covered at 100 percent.
It adds up quick.

Even though he was approved for additional rehab past 20 days, in fact it was recommended by the facility, bills mounted up quickly because only a portion was covered.

Now with catching Covid while he was in rehab, you may have some recourse. Could he be moved to a hospital where he would be covered by insurance due to being a medical patient, not a rehab patient?

Might be the best course of action.

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A medical re-admission to the hospital sounds like an excellent idea. I wonder if that could be done.

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Medicare allows for 100 days of skilled nursing care. The first 20 days are covered at 100 percent and days 21 through 100 at 80 percent Medicare 20 percent co insurance or private pay. Medicare defines a skilled need as physical therapy which skills for occupational or speech therapy, a new feeding tube, IV antibiotics, and certain specialized wound care. Keeping him for care due to the virus does not meet a skilled need. However, to be sure, I would contact Medicare for a review. I'm thinking that it may not be covered. From your statement, it sounds like the facility is responsible. I would speak to the administrator and then if you are not satisfied, go to the level above. I think that this is problematic because since he is positive that limits your options due to the risk of exposure to others.

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That facility should be able to answer that question now. Their billing/social workers should be fully aware of the Medicare rules in regard to Covid. You would not be responsible anyway. They can bill him, but if he doesn't have money to pay, let it go to collection. If they don't give you answers, call your Ombudsman's office. They'll get to the bottom of it.

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"let it go to collection to "? - perhaps the OP doesn't want affect father's credit rating

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Ikdrymom: So sorry that he has signs of the virus (saw your update posted 3 hours ago) and that he had to go to the ER. So does he have Medicare Supplemental to pick up the balance that Medicare won't cover?

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He has Medicare advantage. I won’t call because I never get a correct answer. I am so fed up with this whole system. There had got to be a better way to take care of the elderly. Even when you have a POA half the places still won’t talk to you. And it isn’t as simple as presenting the POA which I was led to believe by the medical staff pushing for me to get it. I had to take a day off of work and spend five hours in a bank just to get his address changed on his bank accounts.

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I am so surprised that even with dealing with people who do this for a living, no one seems to be able to give a clear answer as to what is covered and what isn't.

In the past I have spent hours on the phone with his insurance just getting more and more frustrated. I think things are settled and then find out they aren't.

I am appalled that the rehab facility will even consider charging us full price for days my father had to spend there because he caught the virus in their facility.

You don't even know where to look for answers because everyone I have dealt with in the past has given me bad info. I'm just going to wait until the hospital tells me what the ling term outlook is for my father then ask for one of their social workers to work on a solution that we can all live with.

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Thats what I would do for now. Let the dust settle a little billing wise with Covid and check your EOB’s. New CPT & ICD 10’s are cropping up everywhere for C19 because no protocols exist for Covid 19 coverage and they are developing those as they go.

I suspect none of the major insurance providers Customer service reps will even be able to give you the same answer about coverage during Covid twice.

You can periodically go to the insurance Provider’s website for the “latest” guidelines. An early action was waiving copays & deductibles for C19 in the acute phase but as far as follow up, it’s a work in progress.

Then if you don’t agree with their decision appeal it. You have a pretty good case to prevail. Not your LO’s fault he and you were confronted with a major pandemic after all.

Good luck to you and I bet it all works out!

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Believe it or not someone called me yesterday from his insurance company to give me her contact info in case I had any issues or questions. I explained the situation and she said that as long as the rehab center billed it as covid related it would be covered. The extra days he had to stay should be covered at 80% which I can live with. If I get a bill from them I am to call her first before doing anything. I hope I am not getting my hopes up that I found a competent person to work with on this.

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Wow that is amazing. So glad that the insurance rep reached out to you. Sometimes things do go right. I hope Your father is doing well and will be able to return to AL soon. With all the tests that have been coming up false positive I hope they have rechecked him.

Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?

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