Basically my mother was sent to a nursing home in PA because she had some blood clots and required a 2 person assist. I did some surprise visits last year and found my mother in a zombie like state and never taken out of bed, wasn't getting showers and lost total bowel and bladder control. I pulled her out of there and brought her to FL where she is now walking, recognizing voices on the phone and face to face visits.
This is a long story, but basically once I removed her they demanded total payment in full because they were working on putting her on Medicaid and of course I had to fill out financial papers so they knew how much money she had. That was in July and when I moved her, the assisted living facility I put her in was a private pay. So her money has gone quickly and I no longer have this $16,000.00 in one lump sum. I told them I would make payments and that's not good enough. They are threatening legal action and while I've been paying them monthly, the statement doesn't reflect my payments yet they are cashing the checks.
If I am making an honest attempt to pay monthly, can they still demand full payment? And what kind of attorney or advocate would I need to help me through this. I'm 70 yrs old and feel like I could use an assisted living facility myself. My mother is 89. Any suggestions would be truly appreciated.
This care you described happens every day in some of the best care facilities. Stand up the the payment bullying. And be clear that the service they promised for the price they were asking was not delivered. However do not state this until you have all the paper work. The most interesting thing you will find is that the days you showed up, will most likely different care in writing that was actually received.
I worked credit. I was told by a boss one time that it wasn't in our best interest to sue a customer who was paying on an account every month. No matter how much they were paying. She said the judge would just say they were paying in "good faith" and rule for the person who was paying. It cost a lot to sue. Not sure if 16,000 is worth their trouble.
You should send a certified letter demanding to know where the payments sent have been credited, also tell them that you will only communicate with them in writing via USPS. After that do not answer their calls and continue to send small payments.
It used to be that if you sent a payment, no matter how small, they had to accept it. If they sent the payment back they were saying that the account has been paid in full. I would search that out and find out if it is still the same, perhaps a visit to an elder law attorney. Maybe search online for statutes that governor these issues.
The bottom line is that the money is not there and you can't pay with wishes. Maybe address that in your letter. It will be worth the money to seek legal advice, mom can pay for this as a legitimate spend down expense.
That is the new trend.
It is NOT at all what your mom’s backstory is.
In Pittas, the mom was like 60/61 yrs old and had been in an auto accident. She was hospitalized then moved to a rehab facility. NO MediCARE paying anything. She’s too young for the usual MediCARE eligibility for hospitalization or rehab or other health care costs that MediCARE could be billed for. She filed for Medicaid. She was NOT an elderly old lady with dementia who needed her kids as her DPOA to do her paperwork. She’s like 60/61, she did her application. She is not getting SS, she’s too young for Social Security. There’s no reliable $ from her monthly SS income to get that “Medicaid Pending” copay $ from. From what I’ve read, she didn’t seem to be employed full time. She has a son living in PA and two daughters as well. Facility knows them and their name & addresses on file as family contacts. Son was the primary contact.
Also there was an auto insurance coverage & a lawsuit was anticipated that would eventually enter into paying some costs.
So about 4 months go by and she’s delinquent on her bill. It’s about 80k. Medicaid application needs supporting documentation, which doesn’t happen. Auto lawsuit needs stuff done, which doesn’t happen. Mrs Pittas leaves the facility’s & the bills behind her. And she goes back to live with her husband....... and wait for it... here’s the good part.....
Hubs lives in Greece. Opa!
Yes folks, she leaves the US and goes back to home to Greece. So billing mom, that’s a total waste of time. Instead facility bills the son, he refuses to pay and claims not responsible and properly files for an arbitration hearing to get issue resolved over his mom’s bill. The admissions contract requires billing issues to go to arbitration to be settled. The arbitration hearing - its a small panel that hears each case - goes in the kids favor. Arbitration rules they don’t owe their mom’s bill.
The corporation that owns the facility isn’t happy with the arbitration result (that their contract calls for to be done) and instead decides to sue the son. Personally I think his atty was less than stellar, they “won” in arbitration so probably thought it should be a cakewalk to “win” again in court. His attorney did not enjoin the other siblings in the lawsuit (which he could have done so if they lost the responsibility would be shared equally by the 3 kids). Atty kept referring to arbitration ruling which I bet judge didn’t want to hear. Sonny didn’t bring reams of documentation to show all the exact times he tired to get mom to do stuff, or followed up with auto insurance lawsuit or Medicaid items. Also for PA, it was not a jury trial but only heard and determined by a judge. Judge ruled in facility favor which btw is part of a large national chain owned by a venture capital group. Probably big white shoe law firm to represent facility.
Pittas brief is on law sites. Thomson WestLaw probably best. It is a limited access professional library / resource case law site. Some bigger public libraries have Thomson WestLaw access. There was a sub group on Pittas on Reddit years back, you might be able to slog through to find. Reddit posters layed into his atty, not pretty.
Pittas imo is boogeyman story. Fear & frightening for a circumstance that is really not common.
For most on AC, our folks are/ were elderly - in 80’s or 90’s- & on Medicare & a secondary “gap” or Advantage plan. MediCARE is paying their hospitalization & then 20/21 days of rehab in a SNF if not more. Facilities are getting Medicare $$. If they run out of $ then they apply for Medicaid, their elderly so someone’s going to be DPOA and going to get the info Medicaid needs to move their application and get approved or appealed. They are old & going to be getting Social Security $ or other retirements so there going to be $ to private pay or do Medicaids required copay.
& mom isn’t moving back to Greece.
However, Applicant is required to do a copay also called SOC (share of cost) of almost all their monthly income to the facility during this period of time as they are usually admitted as “Medicaid Pending”. The “usually” tho’ seems to vary by facility as to how hard & fast they are about getting this $ from the resident or whomever in the family is signatories on residents checking account. Most places imply that they are now to become the payee of resident so facility controls their funds. But it does not have to be done. But NH is expecting copay$.
Another sticky - & this can morph into real problem - is as Medicaid retro starts 1st of month, IF they have a secondary health insurance policy (Humana, Blue Cross, United) that existing secondary policy will either suspend or cancel ONCE another newer secondary insurer (like Medicaid) that can pay. This gets kinda convoluted so hang with me...... so gap period btw Nov 15 - Feb 15, they are still technically on Humana, Blue Cross, whatever and those insurers pay bills submitted by providers. ((Now the room& board bill for the NH, that they won’t ever pay)). But if resident gets PT, OT or other medical provider billing (like flu & pneumonia shots) and not billed by NH but by a independent provider at NH to MediCARE and then whatever Medicare doesn’t pay flows over to be billed to the secondary (Humana, Blues). Just like their insurances did when still living at home. But once Medicaid gets approved, Medicaid retro goes into effect. Blues will clawback any payments made between Nov 15-Feb 15 to a provider. Provider will have to resubmit their bill to Medicaid. The sticky is that there could be a lag time in clawback, & lag in the provider actually noticing clawback & in rebill to Medicaid; OR to make this extra special, the provider doesn’t participate in Medicaid. I had this happen with PTs at mom’s first NH; she had high option BCBS virtually zero copay (my dad was a fed) & she moved from NH #1 to much better NH#2 at abt month 9. Mom was approved for Medicaid just short of 6 mos from application date. So both PTs paid by BCBS & both got total clawback. Now I did a letter to NH that BCBS was going to be suspended as per policy requirements once Medicaid approved. But NH did not pass that on to the independent contractors they used (PT, OT, speech therapist at this NH were not staff). Finally almost a yr after first billing the PTs noticed and billed my mom at NH #1. But she was long gone & at NH #2. When finally bills surfaced, it was way way over a year. PT1 said just forgetabtit, but PT2 was quite upset as he did not participate in Medicaid so clawback meant zero $ to him. I offered to pay him a small amount each mo from mom’s $60 PNA and sent him a copy of the letter I sent to the NH as to upcoming Blues suspension of mom’s policy. He threatened to sue, yada yada, but really once they are on LTC Medicaid they are judgement proof. The old NH#1 told him, was not their problem as he was an independent contractor. Why a PT who sees residents in a NH would not be participating vendor for Medicaid is beyond me...
My point is medicaid retro approval can pose issues if other insurance should pay during the months while application is processing. Clawbacks are pretty standard operating procedure by any insurers (auto, health, property) if there’s another payer who can be shifted to pay.
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