By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or
[email protected] to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
*If I am consenting on behalf of someone else, I have the proper authorization to do so. By clicking Get My Results, you agree to our
Privacy Policy. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our
Terms of Use. for information about our privacy practices.
I am confused here. Normally when someone enters a Hospital, goes to a Drs, etc those providers ask for proof of insurance. Medicare being the primary and you have a secondary.*1 The "Hospital" sends a bill to Medicare. Medicare pays 80% of what they feel is reasonable, then that info is sent to the secondary insurance which may pay the balance.*2 If there is a balance left that is Dads responsibility.
Now, if this Hospital bill does not show that Medicare and Dads primary were billed, then you call the Hospital not Medicare. You ask if they have Dads insurance on record, if not you give it to them so they can bill Medicare and the secondary. Once they have the info, you should have no problem if Dad goes to that Hospital again.
Medicare and secondaries send out statements, they are not bills. Medicare shows you what they paid. The secondary shows you what Medicare paid and what they paid and the balance that is what Dad is responsible for to the provider listed. The providers billing should match up to the balance on the secondaries statement.
As said the NH is not responsible for submitting bills from other providers to Medicare. They actually can't.
*1 Not sure how a Medicare Advantage works when it comes to
Providers billing them since they are contracted by Medicare.
*2 with mine and my Moms secondary, there was a "share" clause.
We paid half of the 20% that Medicare did not pay. So we
always had a balance owed the provider.
But I have a ?…. Are they actual bills - like from a specific hospital, MD, lab service - or is it rather a statement of benefits? Or both?
MediCARE sends out - either paper or online - regular statements of benefits to enrollees, whether at home or if they r in a NH. It goes to the address on file, unless somehow he allowed for online / email statements. Almost all in a NH (whether they are medicaid or private pay for room&board costs) are getting something done that MediCARE covers….. like a flu shot, the Covid vaxx, bimonthly MD exam, biweekly “gait training” from the PT or “use of function” work from the OT. So his name, DOB and MediCARE info are floating out there in the health care universe.
Id suggest you go online at CMS (centers for Medicare and Medicaid) to see if you can open an account to access your dads MediCARE summaries. Technically / legally he is supposed to do it, so perhaps gets his info together, take your iPad and sit w him at the NH and obstensibly he does it. Comprende?
Normally, if they leave the NH to go to the ER or end up getting admitted to the hospital, the hospital will have his basic insurance info. His name & DOB will match up for his account w MediCARE. Hospital do real time billing, so something has been filed to his Medicare over the last year ++. He may have a copay depending on what his secondary insurance is or isn’t. If he’s on Medicaid, it should zero out.
Look at the date of service & code on the benefit statements. Things tend to be filed several times b 4 they get paid and then get dropped off a statement. A service could appear from ages ago as well, this especially for ambulance transfer runs (these get filed but get declined so they submit with another code 2 see if it can pass muster, rinse & repeat stuff). MediCARE tends to be pretty strict on providers filing in a timely manner in order to get paid. It may be that Covid gave loads more flexibility in filing. That is something that could be mucho importante for those bills. If a provider did not file a bill at all within say the 120 window as per regulations of the insurer or MediCARE so they won’t pay AND instead they now try to bill you for the full amount THEN you can use this to establish that your dad is not responsible to pay as the provider is out of compliance with thier contract w the insurance co.
Whatever you do, do NOT, again DO NOT ever say or imply that you will pay his bills….. that you will assume responsibility for his financials. Being POA does not mean you are personally responsible 4 his debt. If any bills have gone to collections, those guys are ruthless.