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Basically my mother was sent to a nursing home in PA because she had some blood clots and required a 2 person assist. I did some surprise visits last year and found my mother in a zombie like state and never taken out of bed, wasn't getting showers and lost total bowel and bladder control. I pulled her out of there and brought her to FL where she is now walking, recognizing voices on the phone and face to face visits.


This is a long story, but basically once I removed her they demanded total payment in full because they were working on putting her on Medicaid and of course I had to fill out financial papers so they knew how much money she had. That was in July and when I moved her, the assisted living facility I put her in was a private pay. So her money has gone quickly and I no longer have this $16,000.00 in one lump sum. I told them I would make payments and that's not good enough. They are threatening legal action and while I've been paying them monthly, the statement doesn't reflect my payments yet they are cashing the checks.


If I am making an honest attempt to pay monthly, can they still demand full payment? And what kind of attorney or advocate would I need to help me through this. I'm 70 yrs old and feel like I could use an assisted living facility myself. My mother is 89. Any suggestions would be truly appreciated.

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Segoline - regarding LTC Medicaid retro payments, my experience for my mom & mil in 2 states was once approved & eligible, Medicaid sent out a letter about 3-5 mos later if approved and that eligibility started first day of month application was filed. So As example if submitted Nov 15, &approved Feb 15, the NH would get retro payments for Medicaids daily room & board from 11/15 on. AND Medicaid started Nov 1st (this part can be important). 3 mos. of Medicaid LTC application limbo.

However, Applicant is required to do a copay also called SOC (share of cost) of almost all their monthly income to the facility during this period of time as they are usually admitted as “Medicaid Pending”. The “usually” tho’ seems to vary by facility as to how hard & fast they are about getting this $ from the resident or whomever in the family is signatories on residents checking account. Most places imply that they are now to become the payee of resident so facility controls their funds. But it does not have to be done. But NH is expecting copay$.

Another sticky - & this can morph into real problem - is as Medicaid retro starts 1st of month, IF they have a secondary health insurance policy (Humana, Blue Cross, United) that existing secondary policy will either suspend or cancel ONCE another newer secondary insurer (like Medicaid) that can pay. This gets kinda convoluted so hang with me...... so gap period btw Nov 15 - Feb 15, they are still technically on Humana, Blue Cross, whatever and those insurers pay bills submitted by providers. ((Now the room& board bill for the NH, that they won’t ever pay)). But if resident gets PT, OT or other medical provider billing (like flu & pneumonia shots) and not billed by NH but by a independent provider at NH to MediCARE and then whatever Medicare doesn’t pay flows over to be billed to the secondary (Humana, Blues). Just like their insurances did when still living at home. But once Medicaid gets approved, Medicaid retro goes into effect. Blues will clawback any payments made between Nov 15-Feb 15 to a provider. Provider will have to resubmit their bill to Medicaid. The sticky is that there could be a lag time in clawback, & lag in the provider actually noticing clawback & in rebill to Medicaid; OR to make this extra special, the provider doesn’t participate in Medicaid. I had this happen with PTs at mom’s first NH; she had high option BCBS virtually zero copay (my dad was a fed) & she moved from NH #1 to much better NH#2 at abt month 9. Mom was approved for Medicaid just short of 6 mos from application date. So both PTs paid by BCBS & both got total clawback. Now I did a letter to NH that BCBS was going to be suspended as per policy requirements once Medicaid approved. But NH did not pass that on to the independent contractors they used (PT, OT, speech therapist at this NH were not staff). Finally almost a yr after first billing the PTs noticed and billed my mom at NH #1. But she was long gone & at NH #2. When finally bills surfaced, it was way way over a year. PT1 said just forgetabtit, but PT2 was quite upset as he did not participate in Medicaid so clawback meant zero $ to him. I offered to pay him a small amount each mo from mom’s $60 PNA and sent him a copy of the letter I sent to the NH as to upcoming Blues suspension of mom’s policy. He threatened to sue, yada yada, but really once they are on LTC Medicaid they are judgement proof. The old NH#1 told him, was not their problem as he was an independent contractor. Why a PT who sees residents in a NH would not be participating vendor for Medicaid is beyond me...

My point is medicaid retro approval can pose issues if other insurance should pay during the months while application is processing. Clawbacks are pretty standard operating procedure by any insurers (auto, health, property) if there’s another payer who can be shifted to pay.
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What does the contract say?
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Ask for the phone number for the ombudsman in PA. They are there to help with  LTC issues. If the NH won't give it to you(by law it has to be posted), then call the Office on Aging in PA. In my states the ombudsman works from that office. they are there to make sure Resident Rights are followed.
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The PA filial law that folks refer to is the Pittas case.
It is NOT at all what your mom’s backstory is.

In Pittas, the mom was like 60/61 yrs old and had been in an auto accident. She was hospitalized then moved to a rehab facility. NO MediCARE paying anything. She’s too young for the usual MediCARE eligibility for hospitalization or rehab or other health care costs that MediCARE could be billed for. She filed for Medicaid. She was NOT an elderly old lady with dementia who needed her kids as her DPOA to do her paperwork. She’s like 60/61, she did her application. She is not getting SS, she’s too young for Social Security. There’s no reliable $ from her monthly SS income to get that “Medicaid Pending” copay $ from. From what I’ve read, she didn’t seem to be employed full time. She has a son living in PA and two daughters as well. Facility knows them and their name & addresses on file as family contacts. Son was the primary contact.

Also there was an auto insurance coverage & a lawsuit was anticipated that would eventually enter into paying some costs.

So about 4 months go by and she’s delinquent on her bill. It’s about 80k. Medicaid application needs supporting documentation, which doesn’t happen. Auto lawsuit needs stuff done, which doesn’t happen. Mrs Pittas leaves the facility’s & the bills behind her. And she goes back to live with her husband....... and wait for it... here’s the good part.....

Hubs lives in Greece. Opa!

Yes folks, she leaves the US and goes back to home to Greece. So billing mom, that’s a total waste of time. Instead facility bills the son, he refuses to pay and claims not responsible and properly files for an arbitration hearing to get issue resolved over his mom’s bill. The admissions contract requires billing issues to go to arbitration to be settled. The arbitration hearing - its a small panel that hears each case - goes in the kids favor. Arbitration rules they don’t owe their mom’s bill.

The corporation that owns the facility isn’t happy with the arbitration result (that their contract calls for to be done) and instead decides to sue the son. Personally I think his atty was less than stellar, they “won” in arbitration so probably thought it should be a cakewalk to “win” again in court. His attorney did not enjoin the other siblings in the lawsuit (which he could have done so if they lost the responsibility would be shared equally by the 3 kids). Atty kept referring to arbitration ruling which I bet judge didn’t want to hear. Sonny didn’t bring reams of documentation to show all the exact times he tired to get mom to do stuff, or followed up with auto insurance lawsuit or Medicaid items. Also for PA, it was not a jury trial but only heard and determined by a judge. Judge ruled in facility favor which btw is part of a large national chain owned by a venture capital group. Probably big white shoe law firm to represent facility.

Pittas brief is on law sites. Thomson WestLaw probably best. It is a limited access professional library / resource case law site. Some bigger public libraries have Thomson WestLaw access. There was a sub group on Pittas on Reddit years back, you might be able to slog through to find. Reddit posters layed into his atty, not pretty.

Pittas imo is boogeyman story. Fear & frightening for a circumstance that is really not common.

For most on AC, our folks are/ were elderly - in 80’s or 90’s- & on Medicare & a secondary “gap” or Advantage plan. MediCARE is paying their hospitalization & then 20/21 days of rehab in a SNF if not more. Facilities are getting Medicare $$. If they run out of $ then they apply for Medicaid, their elderly so someone’s going to be DPOA and going to get the info Medicaid needs to move their application and get approved or appealed. They are old & going to be getting Social Security $ or other retirements so there going to be $ to private pay or do Medicaids required copay.

& mom isn’t moving back to Greece.
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What to do.... well to me it all depends on just how much of a lil’ pit bullie you can be & how to approach doing this depends on....
- How did she enter the SNF?
- Was she discharged from a hospitalization (MediCARE) to the SNF for rehab and then after she stopped “progressing” in rehab stayed on as a LTC resident? If so how many days in rehab & how many days in LTC?
- Whose $ is paying the outstanding bill to the PA SNF?
If its you, did you sign a personal responsibility contract with SNF?
if it’s moms $, besides her SS does she have any other income?
- You are not a resident of PA and mom is neither, right? You both are in FL, right? Your a FL resident, right? Do you or mom own any real property in PA?
- What exactly is your source of income and what is your mom’s?
- Was her Medicaid application actually submitted with the required documentation? ..... this would have been a pretty sizeable stack of stuff from months of her bank statements, to her “awards letter” from SSA and any other sources of income to any funeral policy, along with details on an real property owned (home, car, land). The usual is that resident or their dpoa gathers the items up and provides a copy to the faciltiy and in turn the NH submits yiur moms application, the document stack along with their bill to the state Medicaid program. Did this happen? & If so what is its status?
- Did you move mom out of the SNF without discharge paperwork, so she was moved by you AMA (against medical advice)?

I’m going to bet a case of Prosecco, that both you & your mom are totally judgement proof. At 70 & 89, it’s not like either of you can get a wage garnishment placed. LOL. SS & most other retirements income cannot be attached by creditors, so too bad for the NH on that angle. If you or mom stop paying, nothing they can do but be total butt rash debt collection calls. 16k in the world of NH costs is teeeny tiny amount.

And that filial law case for PA, it’s the Pittas case. The situation for Pittas is beyond totally different for the scenario that you are in.
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If they are cashing they checks then they are accepting the payment system that is set.
Besides can't get blood from a turnip.
blessings
hgn
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If your loved one is private pay look at the admission agreement you signed when you moved them in. In there it will tell you that if you are going to leave you have to give prior notice. The notice is either 7, 15 or 30 days. If you give the notice and leave before the days are up the home can legally charge you for the remainder of those days.
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If you don’t have the $$ then pay what you can. I had same situation when I discharged my mother from SNF & the Comptroller pried open the elevator door to ask me if I had a check to give him! & I was on time with paying & it was private pay after insurance no longer paid. They just care about the $$$ & not your mother so don’t ever think that will change. I didn’t want them to clean out my mother’s $$$ life savings so I took her home. Not that my mother appreciates it, because she won’t be happy anywhere. But that’s besides the point. Hugs 🤗
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Get an elder law attorney as something may be amiss here.
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Make sure the application for Medicaid is still continuing to be processed. If she was eligible for Medicaid during that stay they will pay retroactively once it goes though. This will take several months and you will get bills in the meantime. Don't fret and be patient this should eventually get resolved. They are just threatening with collections because they lost a patient they weren't giving good care to. I wouldn't even consider giving them any further payments of any type if the Medicaid application is still being processed. Once that goes though you will never be reimbursed for the money you laid out of pocket and never really owed in the first place.  If it goes to a bill collection service all you need to do is tell them that this is a Medicaid pending case and the facility just wasted a bunch of money for something they can't collect. What I don't understand is why they are billing you in the first place. You don't owe the money, your mother does and if she doesn't have the money to pay as the saying goes can't get money out of a stone.
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Segoline Feb 2019
Do you know what the window for Medicaid paying retroactively is? I am certain that is state specific. Just storing up knowledge here because such a wealth of it.
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Go to a lawyer - have them send a letter to them saying you removed her as THEY did not take good care of her - tell them that if they continue to harass you about the money you will concider suing them for her neglect

I sometimes think the part owners of these places are those are the legislators who won't change health care to help the general person - I do not live in your country so I don't have that worry for which I am very grateful after seeing many such issues in this site
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mally1 Feb 2019
Can I move to where you live?
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Get to an elder law attorney. They'll help you. File a complaint with the ombudsman in the state your mother was staying in. Then tell the facility you've chosen/sought legal counsel.
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With this Sad Situation and the PA Nursing Home Looking like and Acting like the House of Dracula, Tell them that with You Applying for Medicaid because Yes, When Someone, hun, Is Broke, There is NO PAYMENT out of Pocket Now and Somehow...You will Call a Lawyer to Get them off your Back and Make sure they are Told HOW EVERYTHIN IS WHACK.
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You need to consult an attorney. PA is a filial responsibility state and they have come after someone previously. Did you sign any kind of arbitration agreement?
That is the new trend.
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I would first detail the condition of your mother. I would then look over the service/care plan for you mother and her health. I would then DEMAND all her care records. After you have this information I would write a very kind letter letting them know that they in fact did not care for you mother has promised. Outline the care you saw, was witness to and that you will be filing a claim with the DHS Elderly Care Division in that area.

This care you described happens every day in some of the best care facilities. Stand up the the payment bullying. And be clear that the service they promised for the price they were asking was not delivered. However do not state this until you have all the paper work. The most interesting thing you will find is that the days you showed up, will most likely different care in writing that was actually received.
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Are you paying from your moms account? Hopefully you answered yes. You don't want to be personally responsible for her debt.

You should send a certified letter demanding to know where the payments sent have been credited, also tell them that you will only communicate with them in writing via USPS. After that do not answer their calls and continue to send small payments.

It used to be that if you sent a payment, no matter how small, they had to accept it. If they sent the payment back they were saying that the account has been paid in full. I would search that out and find out if it is still the same, perhaps a visit to an elder law attorney. Maybe search online for statutes that governor these issues.

The bottom line is that the money is not there and you can't pay with wishes. Maybe address that in your letter. It will be worth the money to seek legal advice, mom can pay for this as a legitimate spend down expense.
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rovana Feb 2019
The problem here is that PA is a filial responsibility state - it seems that usually they go after children with money, but I expect this filial responsibility thing is spreading fast.  New legal ground being explored.  They may argue that children have to pay up with their own money.
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I would ask why your payments are not showing up on the statement. They may be crediting them to the wrong account. I would call your state Ombudsman and ask if they can make you pay in full or do they need to take payments.

I worked credit. I was told by a boss one time that it wasn't in our best interest to sue a customer who was paying on an account every month. No matter how much they were paying. She said the judge would just say they were paying in "good faith" and rule for the person who was paying. It cost a lot to sue. Not sure if 16,000 is worth their trouble.
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