Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?

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Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?

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Last month my father fell and went to the ER then on to rehab. It was work to find a rehab that would take anyone at this point. He stayed for 40 days which took him through 100% coverage and 80% coverage. AL required two negative Covid tests before re-admittance. His first test was on the 1st and it was negative. The first issue was rehab dropped the ball and did not retest him until the 16th for a 19th discharge date. Test results did not come back in time and they told me if he had to spend the weekend it would be at 100% self pay. At $500 a day I was not happy. Test results come in late on the 19th and they are positive. He has been moved to their covid wing but I haven't received a confirmation that his extended stay will be covered by Medicare. One person said it was covered and another wasn't sure. It is assumed he will be there for most of July and we cannot afford $500 a day especially when they are responsible for his exposure.

Has anyone else had experience with this? Is it covered?

Coronavirus Medicare Paying for Care Rehabilitation Center

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So sorry for your loss. But wonderful you paid someone so helpful. In the end though, if he has no money the bill won't get paid. You cannot be held responsible unless you signed as the responsible party.

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I am sorry for your loss.

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Final update.

The rehab did bill me for the last 5 days he spent there at full price. It was less than I thought but I still don't think I should have to pay 100% of this. Called the insurance rep who had reached out to me before. She is incredible. She told the rehab to apply for a covid related extension. Said she will call when that happens and to not pay the bill I have. Gave me the names and number of the people she talked to. I have never worked with someone so helpful before.

My father passed from Covid on the 11th.

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Believe it or not someone called me yesterday from his insurance company to give me her contact info in case I had any issues or questions. I explained the situation and she said that as long as the rehab center billed it as covid related it would be covered. The extra days he had to stay should be covered at 80% which I can live with. If I get a bill from them I am to call her first before doing anything. I hope I am not getting my hopes up that I found a competent person to work with on this.

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Wow that is amazing. So glad that the insurance rep reached out to you. Sometimes things do go right. I hope Your father is doing well and will be able to return to AL soon. With all the tests that have been coming up false positive I hope they have rechecked him.

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So sorry you are going thru this but all facilities and gov't agencies are swimming in unknown waters right now. If you think the hospitals ran short of PPE equipment you can only begin to imagine the shortage in rehab facilities. Additionally, their staff members were also getting sick and calling out. With all able and available staff directed to the hospitals, it was almost impossible to get any type of medical staff to cover at nursing homes. In other words...... it was pretty ugly for the entire medical industry.
Medicare may not yet have made a definitive decision about how to handle this situation yet. My suggestion would be not to pay anything to the rehab facility until you see something from Medicare. His rent at the AL must be paid if there is a chance of him returning but you need to look at the reality of that. ALs don't provide a lot of service just "assistance". Can Dad live at this level of low care now?
Since Dad has had to stay in rehab for the extra days because of the pandemic, does he need (and can he participate in ) more rehab? If he does and can participate, charges will likely roll back under Medicare (traditional)'s 20/80 rule as he has only used 40 days of his 100 day time set. Good Luck

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To update again. I received a call from hospital telling me they were looking at discharge process for my father to a LTC facility. They gave me a list of places to choose from that take his insurance for short term rehab but will provide long term care. But they haven't officially said for sure he has to go to LTC so I can't vacate his apartment at AL...so he continues to pay on that.

I am trying to find a place that he can 'afford' on private pay for a period of time. While all will take Medicaid, my father helped out grand kids with funds for college 3-4 years ago before he went to AL and anyone knew anything about Medicaid. So now we have that problem. I am sick with worry that his one and only nice gesture will come back and bite me in the butt.

The last thing in this world I ever wanted to see was my father in a nursing home, bedridden. But that looks like where we are headed. At this rate I will pass before he does.

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It is a disgrace. The facilities are trying to get immunity from liability (and in some states they have it) for elderly loved one getting Covaid. So heads you lose, tails they win.

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So true. But think about it, if the facilities are liable & sued, they will not be able to keep open thus seniors will still lose as there will be less places for them to go for LTC. I think in the end liability for LTC should and will be waived.
CDC experts took this pandemic day by day. LTC centers followed the leads and laws set by states and the feds when there were no scientific guidelines due to the mutation of the virus.
Catch 22 situation.

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I am so surprised that even with dealing with people who do this for a living, no one seems to be able to give a clear answer as to what is covered and what isn't.

In the past I have spent hours on the phone with his insurance just getting more and more frustrated. I think things are settled and then find out they aren't.

I am appalled that the rehab facility will even consider charging us full price for days my father had to spend there because he caught the virus in their facility.

You don't even know where to look for answers because everyone I have dealt with in the past has given me bad info. I'm just going to wait until the hospital tells me what the ling term outlook is for my father then ask for one of their social workers to work on a solution that we can all live with.

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Thats what I would do for now. Let the dust settle a little billing wise with Covid and check your EOB’s. New CPT & ICD 10’s are cropping up everywhere for C19 because no protocols exist for Covid 19 coverage and they are developing those as they go.

I suspect none of the major insurance providers Customer service reps will even be able to give you the same answer about coverage during Covid twice.

You can periodically go to the insurance Provider’s website for the “latest” guidelines. An early action was waiving copays & deductibles for C19 in the acute phase but as far as follow up, it’s a work in progress.

Then if you don’t agree with their decision appeal it. You have a pretty good case to prevail. Not your LO’s fault he and you were confronted with a major pandemic after all.

Good luck to you and I bet it all works out!

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Maybe you need to talk to a lawyer.

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Ikdrymom: So sorry that he has signs of the virus (saw your update posted 3 hours ago) and that he had to go to the ER. So does he have Medicare Supplemental to pick up the balance that Medicare won't cover?

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He has Medicare advantage. I won’t call because I never get a correct answer. I am so fed up with this whole system. There had got to be a better way to take care of the elderly. Even when you have a POA half the places still won’t talk to you. And it isn’t as simple as presenting the POA which I was led to believe by the medical staff pushing for me to get it. I had to take a day off of work and spend five hours in a bank just to get his address changed on his bank accounts.

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That facility should be able to answer that question now. Their billing/social workers should be fully aware of the Medicare rules in regard to Covid. You would not be responsible anyway. They can bill him, but if he doesn't have money to pay, let it go to collection. If they don't give you answers, call your Ombudsman's office. They'll get to the bottom of it.

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"let it go to collection to "? - perhaps the OP doesn't want affect father's credit rating

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Medicare allows for 100 days of skilled nursing care. The first 20 days are covered at 100 percent and days 21 through 100 at 80 percent Medicare 20 percent co insurance or private pay. Medicare defines a skilled need as physical therapy which skills for occupational or speech therapy, a new feeding tube, IV antibiotics, and certain specialized wound care. Keeping him for care due to the virus does not meet a skilled need. However, to be sure, I would contact Medicare for a review. I'm thinking that it may not be covered. From your statement, it sounds like the facility is responsible. I would speak to the administrator and then if you are not satisfied, go to the level above. I think that this is problematic because since he is positive that limits your options due to the risk of exposure to others.

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Just a random thought: what do folks do who do NOT have family helping? These issues are overwhelming, even to the smartest of us caregivers.

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No family, the State becomes their guardian.

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I think it is time now to call both medicare and your supplemental insurance for him to check on coverage. The assisted living will still charge; just be certain, now that you are likely in for almost a month, that they are not charging his "care fee".

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Like the others, I suggest asking the billing department at whatever facility he is using AND contacting Medicare to ask that simple question. BUT, since this was not his fault and this is a pandemic, exceptions are being made on things like this. Many exceptions. My GUESS is that Medicare will pay for this and they should under the circumstances. But just call them.

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Not sure what is being done due to the covid crisis but ..since he was actually ready for discharge from rehab before the 20th day, at 100%, I would fight paying anything out of pocket. Just let them bill , if that’s what they try. In some places al had to take back their Pts whether covid positive or not so check out the directives in your area. Lastly, the insurance biz has not caught up with covid yet..I actually read a case where covid is not considered a diagnosis to get home oxygen therapy improved despite the push to keep all but the most critical sufferers at home.

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One usually doesn’t need oxygen post Covid . They are discharged with inhalers and maybe antibiotics if they haven’t completed their course in the hospital. Oxygen post Covid is not usually needed
as it is an acute pneumonia that resolves. The inhalers provide treatment for SOB. I doubt long term Oxygen will be ordered yet approved. The inhalers are meant to improve Oxygen sat %. O2 sats (saturation) are usually back to baseline after Covid. Justification for Oxygen paid for by Medicare at home requires O2 sat values measured while sitting & walking and PFT’s. Not gonna happen post Covid. No medical need.
The post Covid person is then referred to their PCPand/or Pulmonolgy for Covid follow up (CT/Chest done on an interval - baseline post DC on out patient basis then another in 2-3 months & Antibody testing post hospital discharge. The pneumonia is expected to and does resolve.
I work in the field and this is what I am seeing.

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In a similar situation with with my 100 year old dad. I found working with Medicare a very frustrating experience and one must be careful of what is said to the Medicare agent. Now, it is my understanding that if your dad had a condition where he needs to hospitalized, if he is in the hospital
for three days or more, his 100 days of Medicare coverage can kick in again. But how do you get your dad in the hospital is the question. Don’t think his current condition would qualify, however watch for other related conditions like pneumonia. A health insurance agent gave me about the best advice. When it’s time to enroll in new plans, apply for Medicare Advantage as mentioned in another response, he cannot be denied coverage. But I will
be watching for more answers as no one taught us anything about joe to navigate through all
this bureaucracy.

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You have to be careful if your family member has Medicare and a still uses a job insurance as secondary from when they worked. Ex if my parents where to drop Original Medicare and go to an Advantage plan, they could no longer keep their BCBS from when my dad worked. They could no longer have dual coverage. Advantage has some nice benefits but its not worth it for parents as they have no co-pays right now. You have to weigh the pros and cons of Advantage vs Original before making changes.

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This is frightening. I expect this may happen to my mother. Her original facility "transferred" her sometime after we applied for Medicaid. With a 3 hour notice of the actual transfer, she resides quarantined in our least desired COVID ridden facility. We can't afford hospitalization either, so I expect many people are and will be going through bankruptcy. Sadly appreciate all this information.

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Insurance only pays 100 percent for the first 20 days.
After that your dad will be responsible for 50 percent of the daily amount from days 21 to 100.

He is covered for 100 days, but only the first 20 days are covered at 100 percent.

I am going through this with my dad. Just got first bill for days not covered at 100 percent.
It adds up quick.

Even though he was approved for additional rehab past 20 days, in fact it was recommended by the facility, bills mounted up quickly because only a portion was covered.

Now with catching Covid while he was in rehab, you may have some recourse. Could he be moved to a hospital where he would be covered by insurance due to being a medical patient, not a rehab patient?

Might be the best course of action.

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A medical re-admission to the hospital sounds like an excellent idea. I wonder if that could be done.

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medicare pays up to 100 days per benefit period--talk to a social worker
https://www.elderlawanswers.com/medicares-limited-nursing-home-coverage-12131

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You also might see if your father could qualify for Medically Needy/ Share of Cost.

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Call your state’s SHIP or in Florida SHINE for any Medicare information.

From Medicare.gov:
State Health Insurance Assistance Programs (SHIPs)
SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. SHIPs can help you with things like:

Your Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance
Complaints and appeals
Joining or leaving a Medicare Advantage Plan (like an HMO or PPO), any other Medicare health plan, or Medicare Prescription Drug Plan (Part D)
Find contact information for your state's SHIP

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Here is a resource you might try. I’ve never used them but I get an email that tells of how they have helped others with Medicare issues. Let us know if it is helpful for you.
https://www.medicarerights.org/medicare-watch/2020/05/12/what-you-need-to-know-about-coronavirus-and-medicare-coverage

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First Medicare pays the first 20 days at 100%, 21 to 100 days only 50% . The 80% you quoted was what they pay towards Dr. visits, hospital stays etc. And 80% is based on what they consider reasonable. Supplimentals may pick up the 20% in my case they don't. So those 40 days only 20 of them was 100%. The other 20 50%.

Now I am not sure about this, but Dad has 60 days out of the 100 unused? Not sure if he would be entitled to 100% coverage but at least the 50%. I would call Medicare and run this by them. I guess since they couldn't readmit, Medicare will not cover those two days?

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I have found by calling Medicare they have proved to be helpful. In one case I was being charged for what Medicare did not cover. My husband and I went through the local Health Dept. and told them our secondary insurance was a mirror policy of Medicare. They billed us. Medicare advised I call and write them back letting them know what Medicare's response was. Haven't heard from them in months. I would call and ask for a supervisor. I can't wrap my mind around the millions of seniors of being affected and I hope you can find a good resolution to your problem. I care but don't know answers.

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You say "we cannot afford $500 a day". Your father may be billed but you aren't responsible for paying for your father's care. His money pays for his care.

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OK...he cannot afford. I am his financial POA and he has a budget that needs to be followed. While their is wiggle room, it is not up for taking a $10K hit. My concern is that he contracted Covid in their facility and now they expect him to be 100% self pay. I would think Covid should be covered by medicare.

Extended stay at rehab due to exposure to COVID-19 at facility... Will this be covered by Medicare?

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