"Patient paid amount" for month of death in nursing home?

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Post Reply
User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

"Patient paid amount" for month of death in nursing home?

Post by bostondan » Thu May 10, 2018 8:57 pm

I'm not sure if anybody will know the answer to this, but I figured I would give it a shot.

Sadly, my grandmother passed away at the age of 102 in March. She had been living at a nursing home nearby. Each month her room and board were paid for out of her social security ("patient paid amount" or "PPA") and Medicaid, while she was allowed to keep some small amount (I think around $72).

She also had a private room, which I separately paid for at a rate of around $700 per month.

When she died in mid-March, I appropriately received a bill for a partial month of the private room fee at $450. However, I just received an additional bill for $1430.42 that reflects what they are claiming is the remaining PPA. It was my impression that my financial responsibility was only to the private room fee, while all other fees would be collected from her social security and Medicaid.

Does anybody have any knowledge of how this is supposed to work? The finance people at the nursing home are not particularly helpful.

Thanks.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

Flora
Posts: 36
Joined: Sat Mar 26, 2016 6:19 am

Re: "Patient paid amount" for month of death in nursing home?

Post by Flora » Thu May 10, 2018 10:52 pm

How much was her SS per month? I believe that had to be 100% repaid since she did not live the full month.

User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

Re: "Patient paid amount" for month of death in nursing home?

Post by bostondan » Fri May 11, 2018 5:05 am

Flora wrote:
Thu May 10, 2018 10:52 pm
How much was her SS per month? I believe that had to be 100% repaid since she did not live the full month.
It was around $1300. However, it went straight to the nursing home’s bank each month as direct deposit. We did not receive the social security separately.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

mouses
Posts: 3817
Joined: Sat Oct 24, 2015 12:24 am

Re: "Patient paid amount" for month of death in nursing home?

Post by mouses » Fri May 11, 2018 6:28 am

You might call Social Security and see what they say about payments. Or you may be able to tell from the Social Security website if you have access to your grandmother's account there.

What a nice grandson you are. I am sure your grandmother appreciated your help and care.

Jack FFR1846
Posts: 7961
Joined: Tue Dec 31, 2013 7:05 am

Re: "Patient paid amount" for month of death in nursing home?

Post by Jack FFR1846 » Fri May 11, 2018 6:31 am

What does the contract with the nursing home say? Different service, but my son is in a private high school and we pay at the beginning of each month and our contract specifically states that if he does not attend or withdraws, no refund will be offered.
Bogle: Smart Beta is stupid

spectec
Posts: 1226
Joined: Mon Jul 14, 2014 8:00 am

Re: "Patient paid amount" for month of death in nursing home?

Post by spectec » Fri May 11, 2018 7:21 am

It's probably a contractual issue rather than some regulatory matter. I agree with the suggestion to review the agreement with the nursing home. Then a sit-down with someone in authority at the nursing home might enable you to negotiate a settlement of some sort. If they can't point to a clear provision in the agreement that justifies the bill, then you have a good chance of reaching a compromise on the final amount. I second the compliments to you on being a good grandson, and I'm sure your grandmother appreciated your faithfulness.
Don't gamble; take all your savings and buy some good stock and hold it till it goes up, then sell it. If it don't go up, don't buy it. - Will Rogers

Flora
Posts: 36
Joined: Sat Mar 26, 2016 6:19 am

Re: "Patient paid amount" for month of death in nursing home?

Post by Flora » Fri May 11, 2018 8:35 am

The $1300 SS direct deposit to the nursing home's bank account would have subsequently been taken back by SSA (direct debit) so the nursing home was not paid for that portion of your grandmother's care.

Random Poster
Posts: 1678
Joined: Wed Feb 03, 2010 10:17 am

Re: "Patient paid amount" for month of death in nursing home?

Post by Random Poster » Fri May 11, 2018 8:39 am

Who is responsible for the $1430.42 bill?

The Estate? You? Someone else?

If it is the Estate, does the Estate have any assets?

User avatar
Pajamas
Posts: 6015
Joined: Sun Jun 03, 2012 6:32 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by Pajamas » Fri May 11, 2018 9:50 am

Flora wrote:
Fri May 11, 2018 8:35 am
The $1300 SS direct deposit to the nursing home's bank account would have subsequently been taken back by SSA (direct debit) so the nursing home was not paid for that portion of your grandmother's care.
I would think it would be something like this, a timing issue.

Could there have been additional expenses beyond the usual charges? Did they give an itemized bill explaining specifically what it was for? If not, get one.

User avatar
HueyLD
Posts: 6225
Joined: Mon Jan 14, 2008 10:30 am

Re: "Patient paid amount" for month of death in nursing home?

Post by HueyLD » Fri May 11, 2018 11:55 am

bostondan wrote:
Thu May 10, 2018 8:57 pm
I'm not sure if anybody will know the answer to this, but I figured I would give it a shot.

Sadly, my grandmother passed away at the age of 102 in March. She had been living at a nursing home nearby. Each month her room and board were paid for out of her social security ("patient paid amount" or "PPA") and Medicaid, while she was allowed to keep some small amount (I think around $72).

She also had a private room, which I separately paid for at a rate of around $700 per month.

When she died in mid-March, I appropriately received a bill for a partial month of the private room fee at $450. However, I just received an additional bill for $1430.42 that reflects what they are claiming is the remaining PPA. It was my impression that my financial responsibility was only to the private room fee, while all other fees would be collected from her social security and Medicaid.
So, Dan’s grandma died around the middle of March. Questions as follows:

(1). Did the SSA pay grandma’s February benefit in March? Remember SS payments are made in arrears.

(2). If the SSA sent her Feb. benefit to her instead of the nursing home after it was notified of her death in March, she would have owed the facility for the entire month of February plus part of March when she was alive.

(3). If the SSA paid the nursing home her Feb. benefits in March but did not pay her March benefit in April, she would have owed the facility for part of March that she was alive.

Dan needs to ask those specific questions. Ask both the nursing home and the SSA.

staythecourse
Posts: 6121
Joined: Mon Jan 03, 2011 9:40 am

Re: "Patient paid amount" for month of death in nursing home?

Post by staythecourse » Fri May 11, 2018 12:22 pm

Dan,

Informative thread for us all as it is a different world then most of us know about first hand. Advice above seems excellent. Check the contract and unless it says YOU are responsible it should be an issue between them and her estate.

Please give us an update as I am sure many on here would like to know more about how these type of situations finally resolve.

Good luck.

p.s. Not that you asked, but kudos to being a good grandson.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

Re: "Patient paid amount" for month of death in nursing home?

Post by bostondan » Fri May 11, 2018 8:45 pm

Thank you for all the thoughtful replies.

First, my grandmother did not have any assets. They were spent down to pay for the nursing home, after which time all nursing home expenses were paid by social security and Medicare. The only payments that came from me were for the private room. At the time of her death her only bank account was the one held for her by the nursing home that received the social security payments. I did not have access to that account.

I never signed up to be the financial guarantor. My mother was the one who originally signed up for that role, but she passed away in 2016. At that time I took over the private room payments, but signed no additional paperwork stating that I would have any specific responsibilities. I paid for the private room using my credit card.

Below is the only text from the original contract that seems relevant. It says my mother would have been responsible for payment of non-medical services such as personal needs items and beauty parlor charges, since she is the one that signed it, but it isn't clear to me if basic room and board is considered "non-medical services." Since this was a nursing home/rehab, I would imagine basic room and board IS a medical service, much like it would be in a hospital. I assume that is the reason that Medicaid pays for it (after first using social security payments). Also, the first paragraph states that the basic stuff will be payed "exclusively and solely from RESIDENT'S available funds."

Here is the text:
In consideration of the admittance of BOSTONDAN'S GRANDMOTHER, hereinafter called "RESIDENT", to LOCAL BOSTON NURSING HOME (name changed obviously, will call it LBNH below), I hereby guarantee full payment, exclusively and solely from RESIDENT’S available funds, for any medical, physician, or ancillary services not reimbursable by RESIDENT’S insurance coverage(s) or benefits, until medical assistance “MassHealth/Medicaid” coverage is necessary. I further acknowledge that I may not misuse or transfer any Resident’s funds or countable assets that could otherwise be available for Resident’s medical care, and that in the absence of said misuse or transfer will not be responsible for any medical payments on behalf of RESIDENT from my personal funds or resources.

Further, I as the Responsible Party or Authorized Agent agree to act in good faith with on financial matters, and to cooperate with LBNH and the Division of Medical Assistance in the completion and filing of an application for Long-Term Care Medicaid when necessary, and agree to cooperate with any additional Medicaid re- determination compliance or ongoing MassHealth actions.

LBNH’s private pay bills are payable in advance, starting on the day of admission and due the first of each month thereafter. Please see included room rate sheet. LBNH reserves the right to change its rates as it deems necessary, in which case we shall provide you with at least sixty (60) days advance notice in writing, sent to the undersigned at the address printed below, or to such other address as the undersigned may submit in writing to LBNH.

The Responsible Party also guarantees full payment of any non-medical services (such as personal needs items and beauty parlor/barber charges) provided at the request of RESIDENT or guarantor.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

User avatar
arcticpineapplecorp.
Posts: 3336
Joined: Tue Mar 06, 2012 9:22 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by arcticpineapplecorp. » Fri May 11, 2018 9:01 pm

bostondan wrote:
Thu May 10, 2018 8:57 pm
I'm not sure if anybody will know the answer to this, but I figured I would give it a shot.

Sadly, my grandmother passed away at the age of 102 in March. She had been living at a nursing home nearby. Each month her room and board were paid for out of her social security ("patient paid amount" or "PPA") and Medicaid, while she was allowed to keep some small amount (I think around $72).

She also had a private room, which I separately paid for at a rate of around $700 per month.

When she died in mid-March, I appropriately received a bill for a partial month of the private room fee at $450. However, I just received an additional bill for $1430.42 that reflects what they are claiming is the remaining PPA. It was my impression that my financial responsibility was only to the private room fee, while all other fees would be collected from her social security and Medicaid.

Does anybody have any knowledge of how this is supposed to work? The finance people at the nursing home are not particularly helpful.

Thanks.
Sorry for your loss. If your responsibility was for the private room and her responsibility was for the PPA, and her income went to the resident fund at the nursing home, then have you asked them why they're billing you when they received the SS for the month in which she died?

If it was because SSA took back the payment for the final month, then the home is still entitled to payment for that month. How they get paid is another matter.

Did she really spend down ALL her assets to qualify for medicaid? Usually folks can keep around $8000 or $2400 depending on what their income is (though in truth some nursing homes that have fraternal or benevelent care do make clients spend down well below the medicaid resource limits). But are you really saying she had $0 in assets/resources at the time of her death?

At the very least can they prorate her PPA amount as they did for the private room rate? If her normal full month PPA was $1430.42 would they be willing to prorate that since she didn't receive care the entire final month?
"Invest we must." -- Jack Bogle | “The purpose of investing is not to simply optimise returns and make yourself rich. The purpose is not to die poor.” -- William Bernstein

Silk McCue
Posts: 1321
Joined: Thu Feb 25, 2016 7:11 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by Silk McCue » Fri May 11, 2018 9:11 pm

Since your grandmother didn’t have any assets and you were only paying the private room portion the Nursing Home should have no recourse against you and there is no estate to go after. I expect they are just hoping you will pay.

I would inform them that the estate has no assets to pay them. Don’t blink and you should be fine. Make them prove otherwise.

Sorry for your loss.

Cheers

User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

Re: "Patient paid amount" for month of death in nursing home?

Post by bostondan » Fri May 11, 2018 9:30 pm

arcticpineapplecorp. wrote:
Fri May 11, 2018 9:01 pm
Did she really spend down ALL her assets to qualify for medicaid? Usually folks can keep around $8000 or $2400 depending on what their income is (though in truth some nursing homes that have fraternal or benevelent care do make clients spend down well below the medicaid resource limits). But are you really saying she had $0 in assets/resources at the time of her death?
Yes, she had $0 in assets at the time of her death and owned no property. She was allowed to keep $2000 initially, which was spent on private aides to be with her 5 days per week at the nursing home, since the nursing home provided fairly minimal social engagement. Obviously that didn't pay for much, so I continued to pay for the aide and the private room after the $2000 quickly ran out.
Silk McCue wrote:
Fri May 11, 2018 9:11 pm
Since your grandmother didn’t have any assets and you were only paying the private room portion the Nursing Home should have no recourse against you and there is no estate to go after. I expect they are just hoping you will pay.

I would inform them that the estate has no assets to pay them. Don’t blink and you should be fine. Make them prove otherwise.
This sounds like a good approach. After talking to them without much luck, I emailed them stating that I was not responsible for the charges, but didn't comment on the estate having no assets. Depending on the reply from the nursing home, I'll try that next.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

User avatar
Christine_NM
Posts: 2635
Joined: Tue Feb 20, 2007 1:13 am
Location: New Mexico

Re: "Patient paid amount" for month of death in nursing home?

Post by Christine_NM » Fri May 11, 2018 9:33 pm

Different benefits are paid on different schedules.

If it was her own SS benefit, it would be paid in March for the full month of February (assuming she died on or after March 1) and the home could keep it.

I'm guessing she was receiving SS survivor benefit, and since she died in March and the payment was meant for the full month of March, SS has reclaimed it.

See: https://socialsecurityinfo.areavoices.c ... yment-due/

I'd be willing to pay the prorated amount for March but not the full SS benefit.
17% cash 47% stock 36% bond. Retired, w/d rate 2.85%

mouses
Posts: 3817
Joined: Sat Oct 24, 2015 12:24 am

Re: "Patient paid amount" for month of death in nursing home?

Post by mouses » Fri May 11, 2018 9:46 pm

Now that I've read the OP's additional information, I'm thinking the nursing home must encounter this situation a lot. I wonder what normally happens.

Also, it does seem unfair that SS does not pay the last partial month, regardless of whether the person is in a nursing home or not. Not that I expect the government to be fair, just an observation.

I am not sure what the ethical thing is to do in this situation.

SR II
Posts: 132
Joined: Wed Mar 19, 2014 7:37 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by SR II » Fri May 11, 2018 9:47 pm

bostondan wrote:
Fri May 11, 2018 8:45 pm
Thank you for all the thoughtful replies.

First, my grandmother did not have any assets. They were spent down to pay for the nursing home, after which time all nursing home expenses were paid by social security and Medicare. The only payments that came from me were for the private room. At the time of her death her only bank account was the one held for her by the nursing home that received the social security payments. I did not have access to that account.

I never signed up to be the financial guarantor. My mother was the one who originally signed up for that role, but she passed away in 2016. At that time I took over the private room payments, but signed no additional paperwork stating that I would have any specific responsibilities. I paid for the private room using my credit card.

Below is the only text from the original contract that seems relevant. It says my mother would have been responsible for payment of non-medical services such as personal needs items and beauty parlor charges, since she is the one that signed it, but it isn't clear to me if basic room and board is considered "non-medical services." Since this was a nursing home/rehab, I would imagine basic room and board IS a medical service, much like it would be in a hospital. I assume that is the reason that Medicaid pays for it (after first using social security payments). Also, the first paragraph states that the basic stuff will be payed "exclusively and solely from RESIDENT'S available funds."

Here is the text:
In consideration of the admittance of BOSTONDAN'S GRANDMOTHER, hereinafter called "RESIDENT", to LOCAL BOSTON NURSING HOME (name changed obviously, will call it LBNH below), I hereby guarantee full payment, exclusively and solely from RESIDENT’S available funds, for any medical, physician, or ancillary services not reimbursable by RESIDENT’S insurance coverage(s) or benefits, until medical assistance “MassHealth/Medicaid” coverage is necessary. I further acknowledge that I may not misuse or transfer any Resident’s funds or countable assets that could otherwise be available for Resident’s medical care, and that in the absence of said misuse or transfer will not be responsible for any medical payments on behalf of RESIDENT from my personal funds or resources.

Further, I as the Responsible Party or Authorized Agent agree to act in good faith with on financial matters, and to cooperate with LBNH and the Division of Medical Assistance in the completion and filing of an application for Long-Term Care Medicaid when necessary, and agree to cooperate with any additional Medicaid re- determination compliance or ongoing MassHealth actions.

LBNH’s private pay bills are payable in advance, starting on the day of admission and due the first of each month thereafter. Please see included room rate sheet. LBNH reserves the right to change its rates as it deems necessary, in which case we shall provide you with at least sixty (60) days advance notice in writing, sent to the undersigned at the address printed below, or to such other address as the undersigned may submit in writing to LBNH.

The Responsible Party also guarantees full payment of any non-medical services (such as personal needs items and beauty parlor/barber charges) provided at the request of RESIDENT or guarantor.
I think Medicare and Medicaid are two different creatures..Perhaps that is the confusion?

User avatar
pondering
Posts: 1010
Joined: Fri Jan 30, 2015 11:04 pm
Location: 412-977-3526, originally 718-273-2422

Re: "Patient paid amount" for month of death in nursing home?

Post by pondering » Fri May 11, 2018 9:51 pm

I would also say that her room fee should be paid for by her estate. The nursing home seems like they are fishing here.
--Robert Sterbal | 412-977-3526 call/text

jalbert
Posts: 3815
Joined: Fri Apr 10, 2015 12:29 am

Re: "Patient paid amount" for month of death in nursing home?

Post by jalbert » Sat May 12, 2018 1:48 am

Upon death of a recipient, SSA generally claws back the final social security check and the estate must file paperwork to get it. This is to ensure it goes to the correct people or entities.

Thus, I suspect this is what happened, and what is needed is for the estate to pay the nursing home and then file for the final check. Alternatively, an individual might pay it and then be reimbursed once the final SS payment is received from SSA.
Risk is not a guarantor of return.

Mitchell777
Posts: 1026
Joined: Mon May 21, 2007 6:32 am

Re: "Patient paid amount" for month of death in nursing home?

Post by Mitchell777 » Sat May 12, 2018 7:40 am

Sorry for your loss. I understand SS clawing back the monthly payment which they will do. I can't understand why a grandchild would be expected to make it up unless it has something to do with you paying the delta for the private room. I don't think it should but I cannot think of anything else. They will charge you if they think they can get it. When we mother passed they charged her for something that I knew she had not used or needed for the last week of her life. I nicely let them know I wasn't paying it and they rescinded the bill.

pshonore
Posts: 6422
Joined: Sun Jun 28, 2009 2:21 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by pshonore » Sat May 12, 2018 8:33 am

jalbert wrote:
Sat May 12, 2018 1:48 am
Upon death of a recipient, SSA generally claws back the final social security check and the estate must file paperwork to get it. This is to ensure it goes to the correct people or entities.

Thus, I suspect this is what happened, and what is needed is for the estate to pay the nursing home and then file for the final check. Alternatively, an individual might pay it and then be reimbursed once the final SS payment is received from SSA.
A person is not entitled to an SS benefit for the month in which they died. However since SS in paid in arrears, they are entitled to the check received in the month they died because it represents their SS benefit for the previous month.

staythecourse
Posts: 6121
Joined: Mon Jan 03, 2011 9:40 am

Re: "Patient paid amount" for month of death in nursing home?

Post by staythecourse » Sat May 12, 2018 11:09 am

Silk McCue wrote:
Fri May 11, 2018 9:11 pm
Since your grandmother didn’t have any assets and you were only paying the private room portion the Nursing Home should have no recourse against you and there is no estate to go after. I expect they are just hoping you will pay.

I would inform them that the estate has no assets to pay them. Don’t blink and you should be fine. Make them prove otherwise.

Sorry for your loss.

Cheers
The contract is between the NH and your grandmother and that is it. She is dead so the only legal recourse would be through her estate. It is their responsibility to pursue that avenue not yours. They are not dumb. They already know that considering every guest of theirs eventually dies so they will be always owed some money. They are just hoping you pay up without thinking if it is right legally or not. Just tell them to pursue the estate and you have nothing to do with it.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

2cents2
Posts: 328
Joined: Sun Mar 02, 2014 11:31 am

Re: "Patient paid amount" for month of death in nursing home?

Post by 2cents2 » Sun May 13, 2018 3:15 am

jalbert wrote:
Sat May 12, 2018 1:48 am
Upon death of a recipient, SSA generally claws back the final social security check and the estate must file paperwork to get it. This is to ensure it goes to the correct people or entities.

Thus, I suspect this is what happened, and what is needed is for the estate to pay the nursing home and then file for the final check. Alternatively, an individual might pay it and then be reimbursed once the final SS payment is received from SSA.



Would this be the form?
https://www.ssa.gov/forms/ssa-1724.pdf

User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

Re: "Patient paid amount" for month of death in nursing home?

Post by bostondan » Sun May 13, 2018 5:37 am

bostondan wrote:
Fri May 11, 2018 8:45 pm
I never signed up to be the financial guarantor. My mother was the one who originally signed up for that role, but she passed away in 2016. At that time I took over the private room payments, but signed no additional paperwork stating that I would have any specific responsibilities. I paid for the private room using my credit card.
Looking more closely at the bill they sent me, they have me listed as the financial guarantor, despite the fact that I never signed anything or made any such agreement. They are very sneaky.

Thanks for all the advice in this thread. I think I will be able to handle this appropriately. I will post to let everyone know of the final outcome once it is resolved.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

Re: "Patient paid amount" for month of death in nursing home?

Post by bostondan » Wed May 16, 2018 10:12 pm

I just received an even larger bill, stating that they now did not have evidence of my payments for the private room from 10/2016 and 2/2017. The statement that I received had two payments applied to 3/2017, which clearly accounted for the discrepancy with 2/2017.

When I spoke to the "head of patient payments" about this matter, our conversation went like this:

Me: "I believe you've made an error in your accounting. I have records of payment for every month."
Her: "At the end of the day, you owe this money and you didn't pay for October or February. That's an absolute fact that can't be changed."
Me: "It looks like your own statement has my February payment simply lumped with March, but still accounted for."
Her: "Yes, so you now just owe October and that is a fact that absolutely can't be changed."
Me: "It seems that in only a few seconds we just eliminated one month due to an error on your end. Doesn't it seem possible that we might find another error accounting for October given that I have proof that I paid every month?"
Her: "No"

I have emailed them the statements of payment for every month. I'm not sure how much further I'll engage before telling them to simply address further complaints to her estate (which contains zero assets).

Also, I'm surprised how much a highly respected nursing home in Boston (as a physician, it's the place we always tell our patient's is the nicest around) is acting like a typical collection agency. Here were another couple really surprising moments in our conversation:

Me: "I'll email you all the statements of proof of payment for every month later today."
Her: "So you're saying you would rather do this as a payment plan and I can set that up right now?"
Me: "What? How did you possibly think I said that after our conversation up until now??"

And at the end of our conversation, in which I spent literally the entire conversation up until then telling her she had made an error and that I had no intention of paying this:

Me: "Again, I'll email you later showing you the missing payments that you haven't accounted for in your invoice."
Her: "Okay, so I'll go ahead and charge your credit card on file now?"

I spoke to someone at BofA when I was getting the statements and he said that collection agencies often record you in an attempt to claim you agreed to some type of payment plan, trying to get you to accidentally say something that sounds like you agreed. I'm not sure if he is correct, but it certainly seemed that way given how completely out of touch her statements were with the direction of our conversation.

Lastly, my cousin just wants to pay this and be done with it, even if it isn't justified. At the moment I am inclined to continue to fight it.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

CedarWaxWing
Posts: 628
Joined: Sun Nov 02, 2014 12:24 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by CedarWaxWing » Thu May 17, 2018 12:18 am

I would consider asking them for a copy of every bill they sent you over that time period, with their records of payments you paid, and then collect copies of your own proof of payment records, CC or Checks. Staple each proof of payment doc copy to the corresponding bills. May take an hour, but should end the discussion.

Do NOT give them those originals docs to keep, but if necessary make copies of the collection to give them.

If that does not satisfy them... demand to see the CPA who does their audits. IF they have none... threaten to report them to Medicare and Medicaid with all the docs and bills you have organized and have in your hand.... and then follow through on that threat for the sake of every other victim.

As an Md you must know how fun it would be for them to be audited by Medicare or Medicaid... esp if their billing practices are simply not correct. You cannot be the only person who is being treated in this fashion.

Good luck.

User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

Re: "Patient paid amount" for month of death in nursing home?

Post by bostondan » Thu May 17, 2018 5:37 pm

I have decided to no longer engage with them as I am currently. I replied to their latest email and made it VERY clear all the things discussed so far in this thread that were relevant, and said they did NOT have my authorization to make any charges to my credit card (it is on file from prior transactions apparently). I even bolded and underlined the word "NOT" to make it extra clear.

I got this reply:
"Thank you for notifying us on your ability to pay the remainder balance owed on your grandmother's account.

If you would like to establish a payment plan for the balance that currently reads as $1430.42, please reach me by phone. We can also offer an upfront discounted amount."
Really crazy reply to my extremely clear email stating that I would NOT be paying anything and that I considered their charges to be invalid.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

Silk McCue
Posts: 1321
Joined: Thu Feb 25, 2016 7:11 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by Silk McCue » Thu May 17, 2018 6:08 pm

Unbelievable. I would definitely reply to this email refuting their claim that you said you would pay. It’s a pain but you want to be on record for everything. I would consider telling them that if they continue to misrepresent your position that you will engage a lawyer to hold them responsible for deceitful practices and illegal collection activities.

Cheers

User avatar
cockersx3
Posts: 173
Joined: Sun Apr 17, 2016 3:55 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by cockersx3 » Thu May 17, 2018 6:17 pm

I would also cancel the card they have on file, to prevent them from charging it despite your direction to the contrary. Given the behavior from them so far, this doesn't seem outside the realm of possibilities from them.

Sorry you are having to go through this, after years of being a good person and supporting your grandmother financially. Amazing (and sad, unfortunately) to see how people can be.

bayview
Posts: 1565
Joined: Thu Aug 02, 2012 7:05 pm
Location: WNC

Re: "Patient paid amount" for month of death in nursing home?

Post by bayview » Thu May 17, 2018 6:19 pm

Heck, at this point, I’d call the consumer advocate for all your local TV stations and toss them this nice juicy bone. Nothing like getting a bright, unflattering public light blasted on one's business dealings.

Or if you’re feeling generous, give a heads-up first to the SNF that you’re about to do this. :P
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

User avatar
arcticpineapplecorp.
Posts: 3336
Joined: Tue Mar 06, 2012 9:22 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by arcticpineapplecorp. » Thu May 17, 2018 8:49 pm

asking to talk to their chief CPA is not a bad idea (or ask to talk to a supervisor or the head of billing, etc). Could you also try talking to an ombudsman? Could you try talking to the owner of the facility (or the director)? If I were an organization that got numerous referrals (like you apparently give them) I wouldn't want to lose that.

Sorry to hear about the situation going south so fast.

If it ever does go to collections (on you not your grandmom)...say they bill you and you don't pay, make sure to go to court if a collection agency tries to collect. All you have to do is ask them for proof you owe them what they say. Usually they can't provide documentation and the cases are dismissed.

https://www.google.com/search?q=go+to+c ... fox-b-1-ab
"Invest we must." -- Jack Bogle | “The purpose of investing is not to simply optimise returns and make yourself rich. The purpose is not to die poor.” -- William Bernstein

User avatar
bostondan
Posts: 513
Joined: Sun Aug 18, 2013 12:21 pm
Location: Boston, MA

Re: "Patient paid amount" for month of death in nursing home?

Post by bostondan » Thu May 17, 2018 9:14 pm

arcticpineapplecorp. wrote:
Thu May 17, 2018 8:49 pm
asking to talk to their chief CPA is not a bad idea (or ask to talk to a supervisor or the head of billing, etc). Could you also try talking to an ombudsman? Could you try talking to the owner of the facility (or the director)? If I were an organization that got numerous referrals (like you apparently give them) I wouldn't want to lose that.

Sorry to hear about the situation going south so fast.

If it ever does go to collections (on you not your grandmom)...say they bill you and you don't pay, make sure to go to court if a collection agency tries to collect. All you have to do is ask them for proof you owe them what they say. Usually they can't provide documentation and the cases are dismissed.

https://www.google.com/search?q=go+to+c ... fox-b-1-ab
I was wondering if they would try to collect directly from me even though they have no contract with me. Hopefully it won't come to that.

I'm planning to reach out to someone higher up in the institution, but don't yet know who exactly it should be. The social worker that worked with my grandmother is going to email me the information.

I hadn't thought about the fact that I refer many patients to them. There is no question that this rehab/nursing home has lost credibility in my mind after the experiences I have had working with them personally.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

MtnBiker
Posts: 154
Joined: Sun Nov 16, 2014 4:43 pm

Re: "Patient paid amount" for month of death in nursing home?

Post by MtnBiker » Fri May 18, 2018 11:31 am

bostondan wrote:
Fri May 11, 2018 8:45 pm
Thank you for all the thoughtful replies.

First, my grandmother did not have any assets. They were spent down to pay for the nursing home, after which time all nursing home expenses were paid by social security and Medicare. The only payments that came from me were for the private room. At the time of her death her only bank account was the one held for her by the nursing home that received the social security payments. I did not have access to that account.

I never signed up to be the financial guarantor. My mother was the one who originally signed up for that role, but she passed away in 2016. At that time I took over the private room payments, but signed no additional paperwork stating that I would have any specific responsibilities. I paid for the private room using my credit card.

Below is the only text from the original contract that seems relevant. It says my mother would have been responsible for payment of non-medical services such as personal needs items and beauty parlor charges, since she is the one that signed it, but it isn't clear to me if basic room and board is considered "non-medical services." Since this was a nursing home/rehab, I would imagine basic room and board IS a medical service, much like it would be in a hospital. I assume that is the reason that Medicaid pays for it (after first using social security payments). Also, the first paragraph states that the basic stuff will be payed "exclusively and solely from RESIDENT'S available funds."

Here is the text:
In consideration of the admittance of BOSTONDAN'S GRANDMOTHER, hereinafter called "RESIDENT", to LOCAL BOSTON NURSING HOME (name changed obviously, will call it LBNH below), I hereby guarantee full payment, exclusively and solely from RESIDENT’S available funds, for any medical, physician, or ancillary services not reimbursable by RESIDENT’S insurance coverage(s) or benefits, until medical assistance “MassHealth/Medicaid” coverage is necessary. I further acknowledge that I may not misuse or transfer any Resident’s funds or countable assets that could otherwise be available for Resident’s medical care, and that in the absence of said misuse or transfer will not be responsible for any medical payments on behalf of RESIDENT from my personal funds or resources.

Further, I as the Responsible Party or Authorized Agent agree to act in good faith with on financial matters, and to cooperate with LBNH and the Division of Medical Assistance in the completion and filing of an application for Long-Term Care Medicaid when necessary, and agree to cooperate with any additional Medicaid re- determination compliance or ongoing MassHealth actions.

LBNH’s private pay bills are payable in advance, starting on the day of admission and due the first of each month thereafter. Please see included room rate sheet. LBNH reserves the right to change its rates as it deems necessary, in which case we shall provide you with at least sixty (60) days advance notice in writing, sent to the undersigned at the address printed below, or to such other address as the undersigned may submit in writing to LBNH.

The Responsible Party also guarantees full payment of any non-medical services (such as personal needs items and beauty parlor/barber charges) provided at the request of RESIDENT or guarantor.
As I see it the key phrase above is that "bills are payable in advance." Thus the SS payment for the month of February, payable in March, would be used to cover the patient paid amount (PPA) for services rendered in March. If the nursing home received the SS payment issued in March why are they trying to bill for any PPA? If the nursing home never received the SS payment issued in March, where did it go? The nursing home should try to recover the PPA from the person who received the SS payment.

A separate question is why are they billing for about $1,430 in PPA? From the numbers given, one month's PPA would be around $1,230.

Don't know if this helps the OP in any way, but I went through something similar recently. My mother died on September 20. I was her SS representative payee. Her SS payments were deposited on about the third day of each month to a checking account that was held jointly by her and myself. I mailed a check for her PPA to the nursing home at the beginning of each month, as soon as I verified receipt of the SS deposit. My understanding is that the PPA payment made early in September was to pay for her care for the month of September. I was able to notify SS in enough time so that SS did not issue a payment in October. (As mentioned above, SS is paid in arrears, so since she did not live the full month of September, she was not due an October payment).

The nursing home did not bill me for any additional charges for September nor did it issue any refund for pro-rated services not received. (I assume Medicaid - as secondary payer to PPA - received the pro-rata benefit of not paying the full amount for September.) At the time of her death, my mother had a funeral trust and about $1,800 in her checking account. Because the funeral trust was above a certain value, Medicaid (the "Office of Payment Accuracy and Recovery" of the Oregon Department of Human Services) clawed back all of the $1,800. In addition I did receive a refund of about $200 in her personal funds that were being held by the nursing home. This refund was disclosed to Medicaid but the state has not asked for that back.

Post Reply