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Mother is in Nursing Home, and has medicare and long term medicaid that pays for all but her portion - which is of course just shy of her entire social security check.

First, mother had to go to the hospital - instead of ME taking her, they convinced me it would be best to call an ambulance - we would not have to wait as long, her paperwork would be there and ready - ....we waited just as long, and the paperwork took just as long as it would have if I had taken her. A month later, I got a BILL for the ambulance.

She sees the on staff doctor, I like him ok, I think he does a pretty good job considering all of the people he has to see and deal with. I did not like that he suggested to us that we take her to an outside dr. when she was not satisfied with the way he was managing her meds. At first I was angry because I felt that if I had to take her to an outside dr. I should get a discount on the SNF bill because she wasn't seeing someone on their staff, and we would more than likely have to pay the outside dr. HOWEVER I thought about it and he only wants that because he can not make her happy and maybe when another dr gives her the same answers, ....

But I have recently received a bill from the SNF for him and the psychiatrist. I assumed that long term medicaid would pay for the dr. - because, the nursing home told me, long term medicaid paid for everything. So...I am confused.

I am not going to pay the bill. All financial responsibilities are till mothers and I can't pay all of my own bills. What are they going to due? Sue her? They already get all of her money....


My question is though - should she have to pay to see the on staff / on site doctor?

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You know Dixie, it is very frustrating. I just re-read my post to you, I don't mean to imply your dumb, don't take offense! The facilities do a piss-poor job of explaining how the M & M's work. Its complex for all. But for families usually they are placing their parent in a NH when everybody is in crisis mode. Things get overlooked or often family hear what they want to hear "Medicaid covers all", which is not true. Medicaid covers most IF the vendors accept Medicaid.

Reinbursement rate under Medicaid is super low - providers often cannot afford to have Medicaid in their practice if can do just as well without accepting it.
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Went through ambulance billing with my mom's first NH. Bills about $ 700 per trip

Ambulance company is an outside provider, as such they may or may not participate in Medicaid or Medicare. Whatever the case, the transfer fee for the ambulance is a separate bill than anything with the NH. Most ambulance companies participate in Medicare, but Medicare does not pay the entire bill. Someone will be billed the copay. Whomever is on file as financially responsible per the admission contract @ NH will get the bill - it appears to be you. This wasn't an city or county EMS run to the hospital (which is a covered incident), it was an private company ambulance transfer and it sounds like she was an "ambulatory transfer", which if it was coded as such means she could have gone by other means (you take her, by cab) so isn't a covered benefit.

Do I have this right, mom went into the ER, right? Most ER doc's are contract labor & not employees of the hospital; the other doc's (like the ER doc calls for a consult from cardio so a cardiologist come to see mom in the ER) are going to be independent providers with staff privileges at the hospital. As such they bill independently. Again as with the ambulance, they may or may participate in Medicare or Medicaid. If you signed mom in then you need to review the documents - which you are provided a copy of - to see if you signed off for responsibility. If you did, then you will get billed if mom's insurance (Medicare & or Medicaid) doesn't and if you don't pay or come to an agreement to pay, it will be turned over to collections.

What you need to realize is how Medicare & Medicaid work. Google the CMS site for Medicare and your state's DHHS-type of site for Medicaid. Medicaid is paying for mom's room & board charges and Medicaid requires a co-pay or "SOC" of all her monthly income less a small allowance. Medicaid is also paying for the co-pay for anything that is covered by Medicare if the vendor participates in Medicaid. Providers (MD, OT, PT's, etc) do NOT have to participate in Medicare or Medicaid, if they don't & you see them, they bill at their private pay rate. It sounds like this is what happened. If this is still at about month 1, there may be other bills coming in for lab work, radiology, etc as well as they are outside providers too.

You need to be very careful as to what & how you sign documents AND keep all admissions contracts. If you are mom's POA, then every time you sign off as to that. IF not you have signed to be financially responsible.

So are there other issues with this NH? If their approach is for any problems, to have mom go to the ER, this is going to be a constant issue. You many want to look for another NH for her. I moved my mom from NH # 1 within her first year there, was actually pretty simple but requires planning.
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Medicaid/ medicare should cover the ambulance and the separate bill from onsite doctor. You should talk to the nh billing office anout this so that you understand this. In my experience, just because a nh, hospital or doctor issues a bill, it doesn't mean that you need to pay it. You need to understand what is and isn't covered and I believe if you get a bill for ANYTHING now that your mom is in long term care, you should call the business office to discuss it. Start with the question about the ambulance charges.

And yes, the doctor who is on site bills separately, in my experience, but should be covered under medicaid. Again, call the business office.
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