My mother was in an ALF for just one month before she fell and ended up in the emergency room. From there, she went into rehab and a skilled nursing facility.
We paid the AL facility up-front for Mom's expenses and a claim was filed with the LTC insurance company. However, the insurance company requested additional information from the facility and to date the facility has not provided the information.
We left the facility on good terms (I thought) and we've made many very polite and friendly calls and emails to the facility all the way up to the executive director but no one has taken any action. In fact, no one has even had the courtesy to call us back or reply to our emails.
The amount of reimbursement is substantial--nearly $5,000. Is there any recourse for us to get the facility to cooperate and send the necessary information to the LTC insurance company? (We have an elder care attorney but he doesn't handle things like this and could not make a recommendation.)
Thank you.
I’m just wondering if there is a glitch between all the various moves. Like if possibly AL#2 needed something from AL#1 for #2 to process? This is a lot of admission and discharge paperwork going on. Pls pls go over all the paperwork and admission contracts from everyone in this, especially as to resident responsibility.
ALs as their residents have the full on expectation of being able to do their ADLs & perhaps with some assistance, so can take the position that it’s on the residents or their POA to deal with any of this.
fwiw my moms 2nd and eons better NH did not take LTC insurance at all. Signage posted on this. Only private pay or LTC Medicaid. The reasons were many but the main 3 was that immense footdraggin on being paid as lots of requests to data to to type of health care providers time; each LTC insurer had their own criteria so hard to keep up with what’s what and 3. many insurance co stopped underwriting LTC… like the policy was still serviced but the actual insurance company had completely stopped underwriting all LTC plans & the service provider was some 3rd party outfit offshore. Too too bothersome that having LTC Medicaid was way better even if a lower day rate as State paid basically in real time.
Any update for us in the last week or so?
Is the administration cooperative with you at this point?
Would love an update and thinking of you.
And check to see if a local news station has an investigative reporter and let them know. Might be the story they would like.
File complaints with the Attorney General, Better Business Bureau, Consumer Protection Agency and your States Medical Board. Keep copies of all documents/emails/letters
and notes with time/date/person you spoke with as well as what transpired on the phone call. You could record the conversation as long as you tell them you are doing so. If you paid with a credit card you can also dispute the change with the credit card company.
(I highly recommend using a credit card for ANY large “purchase” with any / all place of business)
It is illegal for them to keep your money. If none of these avenues don’t work, file a civil law suit.
Hope this helps.
If push comes to shove you may need to tell them that they really DON'T want bad publicity.
This isn't out of line request. They should be providing this to you. If the cannot, they have Facebook sites and all sorts of ways you can express your chagrin at their not providing information requested by your insurance.
So sorry and wishing you good luck.
Let them know you are part of an elder care Forum that is national and even international, and that you so far have withheld their name. I cannot tell you how pleased I was with all the care in EVERY SINGLE way when my brother was in ALF care with Pacifica Senior Living in Palm Springs. I have given them good publicity here and other places over the period of 5 years since my bro's death. Good publicity is invaluable, and bad will follow one. Let them know that.
Please pls look to see if this is the situation. If her policy does 90, the AL in their experience knows it won’t matter because she left before a full 90 as she became hospitalized. The hospitalization resets the count down.
A ?: is mom currently still in post hospitalization rehab at the NH? If so try to find out IF that LTC policy she has counts the rehab days towards the elimination period. Some will and some won’t. Those that don’t use the reasoning that there are other payors (Medicare and her secondary insurance) covering her costs, even if y’all are doing a copay. So if her LTC policy takes this position, it’s only the day after she exits rehab and becomes a custodial care resident that the elimination period will start. So she will fully be private pay till elimination period is completed. If you think 5K is substantial, be prepared for the NH bill which will be way more than that.