Mom was diagnosed with COPD years ago however, she doesn’t need meds for it, or oxygen or anything. Her AL charges her $205 for COPD management. I’ve argued that there is nothing to manage but they tell me since she was diagnosed with it they have to manage it. I asked WHAT exactly are you managing?? No answer. Her payments are auto deducted so they can take what they want. They’ve also plied on charges back back months. I don’t know what to do.
He scammed tens of millions of dollars from over billing.
our state has numbers you can call to report over billing.
A sticky in all this could be that her AL contract requires written “notice” by her or you as her POA with a fixed exit date in order to wind down her account by choice. It’s something to pay attention to. Not unusual for ILs & ALs charge whatever mo fees EVEN IF resident is in the hospital or in rehab. Please pls read her contract so no surprises.
On another note….. so in your update yesterday…. mom now hospitalized with sepsis? Sepsis is serious. Most facilities will not allow those w/sepsis.
We had this (sepsis) with my MIL. Here’s what ensued: MIL had to leave a State supported IL as she was “increased level of care required”; she was on a State program w/caseworker. Original Medicare and Medicaid 4 health insurance. Mil entered a NH/SNF and under 2K in assets so entered as “LTC Medicaid Pending” w/BIl & SIL closest geographically to her taking the lead on LTC NH Medicaid admissions paperwork. (fwiw none of of kids lived in State). Abt 2 mos in, while LTC Medicaid application undergoing review, MIL got pneumonia. Hospitalized a couple of days, got better, then back to SNF under discharge orders for rehab. Her health insurance paid for hospitalization & would pay for NH/SNF as returning as a post hospitalization rehab patient. Importantly her NH/SNF placed a “bed hold” the entire time in the hospital AND she still was required to pay the SNF her LTC Medicaid Share of Cost of almost all her mo income less the $60 a mo Personal Needs Allowance (LTC Medicaid allows them to keep). LTC Medicaid allows for a “bed hold” for a period of time but have to comply with all requirements that LTC Medicaid sets. The exact terms vary by State.
HOWEVER! as MIL returning to that NH/SNF under rehab orders, it now covered by her health insurance. Not LTC Medicaid. So essentially her LTC Medicaid application suspended while in rehab.
Few weeks go by….. finished rehab (paid by health insurance) & back to a custodial care resident so her LTC Medicaid pending application picks up again. Then she gets pneumonia again & back to the hospital. Very ill & also had sepsis, so hospitalized longer. Her “bed hold” at the SNF removed as she was hospitalized longer than the bed hold allowed by her States LTC Medicaid program. In addition, NH/SNF had it that no admissions with sepsis as they did not do that level of care. She was discharged from the hospital to go to a LTACH. Long Term Acute Care Hospital & as it's “hospitalization”, it was paid by her health insurance. The application for LTC Medicaid to pay the NH/SNF for the days there as a custodial resident still processing along.
LTACH for her was in an adjacent building connected to the hospital by a sky bridge. LTACH by referral only - usually MD who is the hospitalist or oncologist for cancer patients- and it’s usually its own closed ward in a hospital or in an adjacent building. You may find that if your mom stays septic, it will be difficult to find a NH/SNF for her. Ask abt an LTACH as an option.
LTACH tend to run on a 21-30 day admissions cycle. MIL stayed septic and w/cascading organ failure so died @ the LTACH within the 30 days. Her LTC Medicaid application was finally approved months after her death; so the NH/SNF did eventually get paid.
It can be confusing as hell as what health insurance will pay vs. what LTC Medicaid will pay vs what is private pay all varies wildly.
It doesn't sound as if you'll have much luck arguing the billing with this company.
Probably would help if your Mom's pulmonologist provided a letter stating she doesn't require any management right now.
services just removed which reduced her care level by one tier. And frankly, they are now spending more time with her at the reduced service level since they know I’m monitoring to be sure they are following the plan. I think they realize that we may move her if we don’t believe we are getting what we are paying for. You may need to find a different facility if they seem to be just padding her bill and won’t work with you.