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Medicare and Provider Charges

I have been following this forum for the last year and a half or so. Mom was living independently until she had a fall that required followup care in a skilled nursing facility. At the end of the 100 days allowed by Medicare she was dismissed from there. Since she could not remember falling, and was disoriented while she was there I moved her to an assisted living facility. It was impossible to continue to let her live on her own and this was the best solution.

While she was in the skilled nursing facility, I agreed to pay charges that were not covered by Medicare and Secondary Insurance based on a specific estimate.
In the meantime, the Medicare and Secondary insurance statements have been re-submitted numerous times over the past 15 months. Never has a bill be sent to us for the balance due. Thre was considerable physical and occupation therapy during that 100 days that was allowed under medicare and paid. The ALF has an outside company that does PT and OT and they picked up Mom as a patient and then asked me to authorize additional therapy, which was not covered 100%. This appears to have been denied by Medicare, but just now (12 months later) the secondary insurance had paid them directly. Statements were received for the insurance company including a check to Mom. There has not been a bill submitted for us to pay the balance.

I am so confused, as last calendar year, I had allocated money to pay the balance that the nursing home and outside doctors were owed, but no one has billed for their services. I have been told not to worry about it, but it concerns me that I have not paid for services that I agreed to pay for and I wonder if anyone else has had these issues.

It is interesting that the only providers that have billed have been inaccurate - and in most cases, I have had to contact them to say that they should not have billed. Oxygen company charged for oxygen, which was being provided by Hospice. Medicare and the secondary insurance both paid that when they should not have.

I just wondered if this was a typical problem and if others knew how long it might be before these charges are considered to be delinquent and if I have any responsibility to pay when no bills have been submitted.

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