Just found out that my MIL’s SS check is still going into an old account that she had with my husband and my BIL. BIL is spending her check on his own needs. Meanwhile she’s been in the NH since last October and we thought her SS check was going to the NH. Confronted BIL about this and we were told that Integra is paying the bill until February. Really? MIL is 92 and hasn’t had LTC insurance all along ... BIL enrolled her last year maybe when her assets were too high to get Medicaid to get to the 5 year look back. I can’t see an insurance company paying for 16 months of nursing care just because they want to be nice. Usually you have to be a policy holder for years to get any kind of coverage I would think. Can’t figure this out for the life of me so figured I’d ask here if anyone has had this kind of experience.
If necessary contact an attorney to do a bit of forensic study on the account, the insurance .
Have you contacted the Nursing Home to find out exactly how they are being paid?
I also read this is a Medicare Advantage Health insurance plan by the same name. MAs do not usually pay for LTC nor does Medicare itself. I also understand that Longterm care insurance itself needs to be purchased years in advance.
See if husband can get some information from the NH MIL is in. Talk to the billing department and ask if she has a balance due on the acct.
Does BIL have POA? BIL could be brought up on charges for using Mom's SS on himself especially if he is a payee. If DH is still on the account, I would find what rights he has. If none, I would have his name removed because BIL is committing fraud. You may want to consult a lawyer.
If BIL is POA and abusing it, a lawyer maybe able to revoke it. Or, you go thru the expense of becoming MILs guardian. If you win and MIL has the money, you may be able to use her money to pay for it.
February is not that far off. In my State it takes about 90days to get Medicaid. With my Mom, I applied in April, she was placed in LTC May 1st. She private paid May and June which gave me time to get her spent down and the caseworker all the info he needed. June I confirmed he had all the info needed and Medicaid started July 1st.
Once on Medicaid MIL's SS (and any pension) will go towards the cost of her care. I allowed the NH to become payee to my Moms SS and pension. One less thing I had to worry about.
IMO you need to get a handle on this now and that means a lawyer. At least a consult to find out if ur DH could be held responsible in any way for Moms care.
Mom may have been able to qualify for Medicaid if your State allows a Miller trust or something similar. With a MT the money Mom is over goes into the Trust. When she passes, the Trust reverts to Medicaid. Makes sure the lawyer u consult is an elder lawyer versed in Medicaid.
With rehab Medicare pays the first 20 days 100%. 21 to 100 50% which means the patient is responsible for the other 50 %. This is either out of pocket or the secondary pays partial or all of the balance. Depends on how good the secondary policy is? With my Mom, 5 yrs ago she paid $150 a day.
You may want to talk to your County Office of Aging. They maybe able to give you some insight on this insurance especially if Medicaid. At least that will help you understand what is going on.
BIL has to stop spending MILs SS. Since SS does not recognize POAs, your husband may be able to become her payee. Then he can set up a different acct and have her money transferred there.