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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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I've called to try and get the run around. For having both and QMB, I shouldn't be getting sued for Dr. bills. I have had these for years and didn't know it. I need so much help from a doctor but can't figure out insurances. Please help!!
Of course u probably know, that Medicare is your primary. As such they pay 80% of what they approve. Medicaid pays the balance of 20%. My nephew has special needs medicaid so no deductables or copays. Which you may have to meet. If deductables are met, then you owe nothing. If not, you r responsible for the balances.
Ex: lets say a doctor bills $100, Medicare approves $80, 80% of that is $64 leaving a balance of $16 for Medicaid to pick up if you have met deductibles.
Your problem may be that for Medicaid to pay you must use their doctors in the state you live in. Meaning a doctor needs to be able to bill Medicaid. Same with Medicare, if doctor doesn't except Medicare he can't bill them so you owe the balances.
Where I live the Office of Aging has someone who can help you understand how this all works.
thank you!! Do you know if you get a medicaid card? Ive never gotton one. Also, how do I go about getting eye exams and glasses? I havnt gone in 5 years and really need to. Cant they assign someone to me to talk thru all this?
In the state of NJ, yes my nephew has a card. He has to chose a PCP so the doctor is on the card. He shows the card to an eye doctor and dentist that Medicaid approves. Call ur Social Service dept. And see if you need a card.
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.
Ex: lets say a doctor bills $100, Medicare approves $80, 80% of that is $64 leaving a balance of $16 for Medicaid to pick up if you have met deductibles.
Your problem may be that for Medicaid to pay you must use their doctors in the state you live in. Meaning a doctor needs to be able to bill Medicaid. Same with Medicare, if doctor doesn't except Medicare he can't bill them so you owe the balances.
Where I live the Office of Aging has someone who can help you understand how this all works.
It looks like it is a program that pays your premiums and deductibles.
So, as JoAnn said, you shouldn’t owe anything BUT you do have to go to a doctor who participates in this program. AND, when you go for services, you need to make sure the doctors called in accept your type coverage. Someone else will have to explain how you do that, I’m not aware.
https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/QMB.html