Suspicious Nursing Home Bill--Advice Welcome!

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  1. ncmonroe1981 profile image60
    ncmonroe1981posted 12 years ago

    Dear fellow hubbers,

    I live in West Virginia, U.S. I am helping to take care of my boyfriend's uncle who is disabled and wheelchair-bound. There was a period of transition between the time he left his apartment, but before our home was ready for him. During that period he stayed at a local nursing home. Upon admission, one of our first concerns was the cost. The social worker at the facility explained that because of the kind of Medicare/Medicaid plans he had, he was entitled to stay there for the first 100 days, and the state would pay for them. We asked specifically if any money needed to come out of pocket, OR out of his monthly checks; we were told in no uncertain terms that his first one hundred days were taken care of, and that nothing would come out of his checks.

    Our uncle stayed in the nursing almost all 100 days, and when it was time for him to come home, a woman from the facility's business office presented him with a bill for around $1000.00 and asked if he had his check book handy, even though everyone in the facility was made aware that I was his POA, and all inquiries should be directed to me.

    When I found out about this episode, I was very upset, and visited the business office personally. I was told at that time that the worker in the business office had made a mistake, that our uncle did NOT have any bill at all.

    Three months later, they sent a nasty letter threatening legal action if he did not pay immediately. I called the facility and spoke with the supervisor of the business office, explained the above situation and made it clear that we would not pay anything until we were presented with proof of the validity of the bill in the form of records to Medicaid/Medicare about what has been paid for and an itemized list of services that have not been paid for. She told me she would send those documents.

    That was three months ago. I heard nothing from them until right before Christmas when I received another similar nasty letter. I called the same supervisor again and reminded her of the situation. She said again that she would send the itemized list. Today, I received in the mail 2 pieces of paper from the nursing home that have nothing written on them except my uncle's name, the facility's name and address, a space to list dates, services, prices, and a total. The space for including services is blank-not a single service is listed, but there is a "total due." In other words, this looks like a bill, but there are no services or items listed, only a price due.

    Can anyone give me any advice in this situation? How can I go about determining if this is a valid bill, or if they've already billed the state for these things? Who does one get in touch with for legal aid/nursing home assistance? What would you do in my/my uncle's situation? We have no problem paying the bill if it's legitimate, and have even stated so; we've even offered to pay $50.00-$100.00 per month, if they will show what services they are billing for. They seem bent on being paid the full amount, and they seem to be playing games about the itemized list. How can I find out more about my uncle's rights as a consumer of nursing home services?

    Thank you all in advance!

    1. leinstergoddess profile image61
      leinstergoddessposted 12 years agoin reply to this
    2. leinstergoddess profile image61
      leinstergoddessposted 12 years agoin reply to this
    3. profile image0
      cosetteposted 12 years agoin reply to this

      they keep records and they should be able to produce a billing statement for any and all services your uncle received while under their care. for her to ask a frail elderly gentleman for payment seems like intimidation on her part and is inexcusable. why should you pay for something when you don't know what you are paying for?

      i would definitely arm myself with all paperwork from medicaid, names, dates, etc. and fight this. good luck.

    4. profile image0
      B.C. BOUTIQUEposted 12 years agoin reply to this

      you need to bring it up with the advocate for the elderly and disabled, there is one from the state that is stationed in every home ( this is a US law ) ..they might not always be available, but the front desk has to show you where in the home their ofice is and if they are not in has to give you their phone them immediatly
      something very suspicious has happened here, the advocate will invesgtigate the bill, along with the state and you will most likely not have a bill that is that high..I can almost 100 percent guarantee it..
      please get to the advocate asap..tomarrow if you can!

  2. scourtney profile image60
    scourtneyposted 12 years ago

    I've been involved in health professions for many years and the  bill seems very reasonable to me. Offer to pay them what you can afford to each month. If you can somehow manage to pay in cash, offer them 50 to 75% of the total. They may just take it. Good luck.

  3. profile image0
    lynnechandlerposted 12 years ago

    Did I miss something when I was reading this? How is a blank bill with a fee attached reasonable?

    I would try to find an advocate for the medicare your uncle is under that can help you get to the bottom of this. Barring that search out a lawyer experienced in medicare billing and see if he can get them to produce an actual bill for services.

    You should have received a statement from medicare saying they had paid x company for x amount for the time he was in the nursing home.

    1. AEvans profile image75
      AEvansposted 12 years agoin reply to this

      I definitely concur! smile

  4. ncmonroe1981 profile image60
    ncmonroe1981posted 12 years ago

    Thanks for the advice and encouragement, guys. I appreciate it. If anything else comes to mind, please let me know. I'll be looking for some phone numbers soon.

  5. Dame Scribe profile image59
    Dame Scribeposted 12 years ago

    I would also suggest that verbal communications *said* should be documented and signed wink I agree with lynnechandler. Best to always have a *paper trail.*

  6. Misha profile image64
    Mishaposted 12 years ago

    Yep, I third or fourth this. Paper. Certified mail, leaving a copy for yourself. No blaming, emotions, etc. State facts as you see them, and what you want those guys to do. Good luck. smile

    Read this as an example, it was for real and it worked. … d-it-first

  7. ncmonroe1981 profile image60
    ncmonroe1981posted 12 years ago

    Great advice, guys! Misha, thank you for the example letter; I'll be working on one of those to send via certified mail over the next few days.

    I really appreciate all the help and encouragement!

    1. RN Health Advisor profile image55
      RN Health Advisorposted 12 years agoin reply to this

      Every state is required by federal mandate to have what is called an Ombudsman.  Their sole purpose is to investigate any and all complaints about nursing homes and to advocate for the patients.  You may also want to contact the Joint Commission of Accredited Hospitals in your state.  This is the licensing agency for all nursing homes.  I think both agencies would be very interested in your story.  Good luck!

      1. ncmonroe1981 profile image60
        ncmonroe1981posted 12 years agoin reply to this

        RN Health Advisor: Thank you! That's excellent advice. Perhaps when I write out my letter to send to the nursing home, I should forward copies of it to those institutions as well. I will definitely check them out!

  8. profile image0
    B.C. BOUTIQUEposted 12 years ago

    I only know this because at the age of 29 I had to stay in a nursing facility ( home ) for 4 months and some bad things happened ( yes, I am permanently disabled ) husband found out about the advocate and in days things were settled and I got the care I was there to get and was not forced into the activities set up for the elderly, I was there to heal from a major surgery after a bad spilland the insurance thoiught it was best I has =d 24 hour nuring care and it was cheaper than having an RN at my home on 3 shifts...

    I would explain the story, but I am too embarrassed to, please see the advocate immediatly!

    1. ncmonroe1981 profile image60
      ncmonroe1981posted 12 years agoin reply to this

      Thank you B.C. BOUTIQUE! I'm sorry about your experiences-no need to share, but also probably no need to be embarrassed, either. You seem like a very nice person.

      I will contact the advocate as soon as possible!

      1. profile image0
        RTalloniposted 12 years agoin reply to this

        I just found out about Elder Care Attorneys and wrote a short hub on them.  The advice on an advocate or ombudsman is excellent but a certified Elder Care Attorney can possibly cover more ground more quickly for you.


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