by Guest » Wed Nov 10, 2010 02:38 am
Someone told me they had to take their very frail and demented family member out of an Ohio skilled nursing home because they couldn't afford to private pay while awaiting Medicaid approval once their full coverage Medicare days had expired. Does this sound correct?
Posted: Wed Nov 10, 2010 02:41 am Post Subject:
Do you mean they went for this federal insurance cover and while waiting for approval to get their family member treated? well sounds familiar.
Posted: Wed Nov 10, 2010 03:56 pm Post Subject:
because they couldn't afford to private pay while awaiting Medicaid approval once their full coverage Medicare days had expired. Does this sound correct?
Correct or not? I'm not going to say. But it usually doesn't happen this way. If a person is in need of skilled nursing care, and it is reasonably known that more than 100 days will be required there (not usual, some lower standard of care is typical, and I don't think a "frail and demented" person needs "skilled" nursing care), the nursing facility, knowing that people won't be able to pay the full cost, will initiate or recommend applying for Medicaid ASAP, not at the time Medicare payments run out.
If there is a high likelihood that a person will qualify for Medicaid, the SNF (or other facility) will not force the person out, but will wait for the final determination, and if approved, the past due expenses will be paid retroactively by Medicaid. It doesn't normally take that long to run the qualification maze if the paperwork is complete.
On the other hand, if we're not really talking about a Medicare Part A claim preceding the "having to take the person out" of the facility, then the reason for that is the medical insurance benefit ran out, and no one thought about applying for Medicaid. Even still, most facilities are not going to force a person out, if there is a reasonable expectation of collecting from Medicaid.
Posted: Thu Nov 11, 2010 01:40 pm Post Subject:
Again, knowledge is a valuable tool in navigating life. When you don't understand the rules, you typically fail miserably.
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