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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.

Celia
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Hello,
I am a medical biller in NJ for the last 27yrs. I also was my parents POA. I am quite familiar with this sort of billing and most Rehab facilities participate in Medicare. (which means accepts what medicare pays as payment in full) So there should not be balances for services, except if there is additional days not covered by Medicare which is then paid by the patient if they do not have a supplimental plan. Hopefully I am understanding your post correctly. I would most definitely contact the billing department of the facility and discuss this further and not wait for a surprise bill. As for the account being past due, it is only past due 90 days from the first bill. Make sure you document whom you spoke with and your conversation and confirm addresses and phone numbers. Checking prior to paying bills is for sure a plus. This is for sure a problem, insurance fraud as well. Overcharging and charging for services not performed as well.
Best of luck and hope I helped somewhat.
Hugs,
Robin
Hi Celia.

Okay, my experience of this is from 2005, before Part D and other changes...

My understanding is that after hospital care, a patient can go to skilled nursing where Medicare pays 80% and the secondary (Part C) provider pays 20% for 20-25 days (this may vary by state and time of event). Medicare will continue to pay the 80% up to 100 days from date of admission. Typically the patient or family pays for non-covered expense. Most facilities allow for a payment schedule.

Medicare will only pay for so many days of PT and OT, which must be requested by her physician for each group of sessions. Again, the provider should bill Medicare directly and her Part C should pick up the rest.

You can ask for a detailed statement from each facility and provider that covers a range of dates, showing charges and payments on her account. You should probably do this anyway to document what's going on. Also (I found out the hard way) providers seldom send a statement when the balance is paid in full unless you specifically request it.

She should be getting statements from Medicare and her Part C company, showing what's been submitted and what they paid. If they are paying providers you've never heard of, note the dates and ask the facility where she was at that time to see if they authorized a consultation or treatment you didn't know about.

Hope this helps.
Good luck.

Hugs,
Barb

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