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My MIL has a big claim that was denied by Medicare. I haven't received a bill yet from the nursing facility where MIL was sent to rehab. I'm looking in to disputing this with Medicare and, with the possibility that she does have to pay, I also want to look into negotiating a smaller charge or making small monthly payments on the bill (should it come to that).


First, I need to complete trying to find out if something in the hospital record could be changed that would make it be covered. Also, the rehab/nursing home staff failed to notice a key inconsistency in MIL's discharge summary, which they should have called to clarify with the hospital. They didn't and instead told me MIL was covered by insurance for several weeks. So I need to find out what that means in regards to paying should this fail a Medicare appeal.


So, what do I do when I get that bill? I surely won't have all of this sorted out yet. It seems like I shouldn't just let it default, but I also don't know if I should send in any payment on it (even the $5 a month some have suggested to me) if we don't know yet if we'll have to pay it. AND if we do have to pay it, I'd like to try to figure out the best way to negotiate a reduction in cost - and again, would need to do that, I think, before I send a dime in payment.


So, what do I do when I get the bill?

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Overwhemed, you can do nothing until you have the bill from the NH and statements from Medicare and the supplement. You then compare the statement to the billing. When you do, you can start to negotiate. This was their error but Mom did have care. Not sure if they will write off the whole amount.

IMO, if there was no error, the most Mom would owe would be the days after the 20 and 50% of that balance. You have no idea until you receive the bill what your being billed. The NH may have already made adjustments. You won't know till u receive the bill. If its been a while, I would call their billing dept and ask for the bill.
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Overwhelmed23 Aug 2023
I'm dreading that bill honestly, can't bring myself to call and ask for it. They'll send it when they do, I guess. I did ask for intake paperwork as I need to verify some things on there, which I'm hoping they'll send once they look at the poa and doctor's letter I sent. Which someone else at rehab already had, but it didn't go in the official file, I guess. I'm just worried the wrong move on my part will make things worse.

Caring for her has been rough the past few years, she's a very difficult, passive-aggressive, secretive and manipulative person. There's a reason no other family will have anything to do with her. I thought I was going to maybe finally get a chance to breathe now that she's in Assisted Living, maybe try to climb out of the depression and anxiety I'm dealing with. Then the Medicare claim statement came. And now that's something else big that feels complex (appeal? Fight rehab due to their mistake - but how, a lawyer's cost probably isn't justified? make payments, seek debt reduction, and again, the best way to do that)? This isn't that cut-and-dried, to me, at this point. I have anxiety issues, I always see all the possible problems and try to problem-solve. To an extent that is good, and to an extent it can make me go down roads I don't need to worry about. But it's hard to separate those roads when you have anxiety issues.
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Saw your response to me. I too used to think too far ahead. Being in accts receivable and collections I learned u can't do anything until the bill arrives. As MD said, this is not your error. And again, the letter u have telling Mom her Rehab has a date. Thats probably the same date the NH received the notice and they allowed Mom to stay. Call ur Office of Aging and see if, after u get the bill, if there is someone that can help u sort it out.

With the bill you got with two days to pay...next time keep the envelope showing the date it was mailed. That's the date you go by. Can't pay a bill on time, if the bill was not billed on time.

Collectors, there are laws to protect you from harassment. With a cell you can block their #s.
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How do you know that your MIL’s claim was denied by Medicare? Did she receive an EOB from Medicare stating that her claim was denied? Medicare ALWAYS sends out an EOB after medical care is provided. If you did receive an EOB from Medicare, you can appeal their decision. Your appeal has to be in writing. If you have the EOB showing the denial, you can just simply fill out the appeal form and send it to Medicare. Just remember there’s a limited time for the appeal and the date will be listed on the EOB appeal section. Otherwise, call the nursing facility and find out why Medicare is denying the claim. Also, you can ask the facility to put your MIL on a payment plan if you believe that she has to pay the bill. DO NOT take it upon yourself to send in $5 as monthly payment without getting permission from the billing company to do so.
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This is a duplicate,

https://www.agingcare.com/questions/medicare-denied-payment-of-snf-stay-how-to-negotiate-lower-bill-with-the-facility-482976.htm

Overwhelmed please go to ur previous post. There are answers there. One is mine. I think I covered this question.
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Try to find a friend, someone who’s been in a similar situation and what did they do. Or ask some of your older friends, whose judgement you trust.
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