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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.
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I had full Medicaid for the last 5 years, no Medicare because I was fighting SS. No medical doctor who didn't accept Medicaid would see me at all if they were not a participating Medicaid doctor. They just would tell me up front. Most doctors do not accept it. I had a lot more luck with doctors working at actual hospitals, or off-site from a hospital but still using the name. But if you have Medicare with Medicaid as a back-up, as I do now, it's a whole lot more confusing. Straight Medicaid, you should never get a bill, either they accept it or they don't.
Medicaid will only kick in after all your financial savings are depleted to the required level, excluding a house, one car and a small amount of savings.
If your mother has too much in the bank or a stock account or anywhere else, she may have to spend down her money before medicaid will pay.
Medicaid has a 5 year look back. That means that she can not give money away or hide it in someone else's bank account to qualify for medicaid.
Medicare does have copays and deductibles, and it depends on which Medicare plan you have as to how much those may be. Medicaid particulars vary with each State, since each State manages it own plan.
Not all physicians "participate" with Medicare, even if they accept the insurance. Some only accept certain Medicare Advantage plans. (For example, my family MD does not accept United Health or Humana Medicare plans.)
The answer to your question depends, in part, on the type of Medicaid assistance you are receiving and the state in which you reside. Are you receiving "Community Medicaid" or are you participating in a "Medicare Savings Program". If, for instance, you are participating in the Qualified Medicare Beneficiary ("QMB") Medicare Savings Program, then Medicare providers are prohibited by Federal Law to charge the patient anything above Medicare's reimbursement and the state's Medicaid payment (if any) irrespective as to whether or not the provider participates in a given state's Medicaid program. Background can be found here: www.ssa.gov/OP_Home/ssact/title19/1902.htm But you may be better off calling Medicare (1-800-MEDICARE) to discuss your particular circumstances or search the Medicare.gov website for more information.
Again please read the new tax bill within the 2018 tax bill anything that adds to our national DEBT which includes the 1 to 5 trillion we added these cuts come automatically. Look up pay/go put into place. These cuts come out of the safety net social security & Medicare & Medicaid! Now most Doctors will not allow Medicaid!
My Mom also has Medicare and Medicaid. Often times when she gets a bill it is because they failed to balance bill Medicaid. It is extra work for billing office so it is up to you to make sure they are billing both insurances. Don't pay any bills. It is easier for them to send you a bill and hope they can collect than to bill and wait on Medicaid. If you continue to have problems call your local Office for Aging and they have special Insurance councellors to help with these very problems.
If you need more help try the County Office on Aging. I live in Riverside County, California and they have a special program to help you with the process.
Rather than asking a question here without giving any detail, i.e. how much the "high co-pays" are, what you have been billed for, etc., you should: 1.) Call the provider you are receiving bills from & ask them why they are billing you; 2.) Call Medicare & Medicaid and ask about the bills for co-pays; 3.) Make sure that the providers you see accept Medicaid.
Many providers no longer accept Medicaid for office visits & other services. If you want to go to doctors/providers that do not accept Medicaid, you will be responsible for 20% of the total amount billed.
My nephew was on full Medicaid and his neurologist didn't take it so he had to switch to Medicaid doctor. When he received Medicare, Medicaid became his secondary. His previous doctor allowed him to come back because as secondary, Medicaid paid quicker. He has a Primary that excepts Medicare but not Medicaid so my nephew pays the difference. On full Medicaid you have to use their doctors as a secondary you can but don't have to. But, u will be responsible for the 20% Medicare doesn't pay.
Many doctors and other practitioners are no longer accepting Medicare and Medicaid because the reimbursements to them are so low they cannot make a livable wage. Younger practitioners cannot afford to live and pay off student loans.
My husband and I both are licensed clinical psychologists. I am also a licensed mental health evaluator. We both are registered Medicaid and Medicare practitioners. We have been able to stay in practice because we have other income sources. We used to receive $67.00 per billable hour reimbursement from Medicare and $59.00 from Medicaid. For a group session it was $13.00. It sounds like a lot of money, but it isn’t. From that amount one must pay for office space, taxes, supplies, continuing education training, utilities, Worker’s Comp, clerical support, computer equipment, billing software to meet reporting/billing requirements for insurance and government and licensing costs. And then the big thing, liability insurance for our office space -and ourselves. Every year the premium goes up. Congress wants nothing more than to cut back on Medicare and Medicaid. I only practice on a very limited basis. My husband works full time. He only has a limited number of Medicaid patients who are children and accepts no Medicare patients. He probably will stop accepting Medicaid in the fall. Reimbursements to practitioners at all levels are inadequate.
Since 2014, the list of physicians who no longer accept medicaid has been growing longer and longer. The "affordable health care" system is an attempt to help a great many more people, thus taking away more and more from the elderly population, in my opinion. Doctors who once accepted medicaid patients no longer do. If you don't have enough Medicaid docs/specialists in the area, try to scrape together enough for a decent supplemental plan. In my state, an elderly person can have Medicare A and B as their primary, a supplemental policy as their secondary, and Medicaid as their tertiary. Medicaid is fine with it and you then have more choices in medical care. This arrangement can follow the patient right into nursing home care. The secondary premium amount is deducted from the patient pay amount.
I agree with jeannegibbs. They probably either don't have your Medicaid info, or they don't accept Medicaid, which they should have informed you up front. Normally, with both coverages, you should not have to pay a copay. If your Dr does not take the Medicaid plan you are on, you will have to switch doctors or try to get on another plan. On another topic, do NOT get a combined plan like Humana as AliBobali suggests. They are notorious for not paying, and many more doctors are not accepting them, either. I can tell you from when I worked in the hospital, their coverage is very limited as well. They will deny tests and surgeries faster than you can blink. If you are healthy and never need them, yes, they save you money on your monthly premium. But if you have chronic health problems and need frequent care, they are not your best choice. If you ever need rehab after hip or knee surgery, their coverage is horrible.
Due to the new budget bill 2018, thing are drastically Changing. No longer are post/op bills being payed. There are more cuts in store. They are trying to cut Medicaid all together, and starting to cut nursing home payments. These cuts come because the new tax bill must be payed. Look up a bill called pay/go. Put into place in 2010. These cuts are automatic. And can’t be stopped. When we add to our national debt, these cuts come. It is your responsibility to understand your co-pays .
Becky04473 brings up a valid point - I had to ask up front before going back into any examination room if they accepted Medicaid. I was disabled for 9 months with my back.
My advice would be to contact Medicare & Medicaid, starting with Medicaid.
When a hospital tried to bill me for a CAT-scan - I contacted Medicaid. They said to tell the hospital that they had already receive a Medicaid payment and as long as they had accepted it, I owed nothing. I never got another billing.
Everyone will try to collect whatever they can. But if they accept as much as $1 from Medicaid, you are not supposed to owe. Contact your Medicaid office - I was helped over the phone.
The kicker is, CAT-scans are not covered but the hospital had assured me when I arrived that it was covered. They billed it as some other, acceptable, test. Medicaid was hoping the hospital would pursue the issue and they would have taken the hospital to court. But the hospital backed down.
This is why you always must ask before you get any treatment. I even had to ask the Dentist before I went into the examination room.
I think with Medicaid it also depends on your income. My nephew gets special help because he is very low income. He pays a small amount for prescriptions. Like said, you have to go to a Medicaid doctor. A doctor who doesn't take Medicaid is not suppose to see you. When you signed up for Medicaid you needed to pick a doctor from their list.
Our local Office of the aging handles the Medicaid health insurance. Call them and ask if you can sit with someone who can explain how your medicaid healthcare works. Maybe some adjustment can be made.
If you decide to switch to an integrated Medicare/Medicaid plan be sure to check and see if their drug formularies have your medications included. You will still have to check to make sure your doctors are providers to the integrated plan. There could be some unpleasant surprises if the plan is not an approved provider. No provider has to accept Medicaid and Medicare.
I had to contact the medical billing office and my dad's integrated Medicare-Medicaid provider (Humana) many times for bills my father received. Often it was a case of a billing error, either at the doctor's office or with Medicaid, or Medicaid was being very slow to pay.
Do they offer integrated Medciare-Medicaid plan options in your area? If you were to change to the integrated, it could help to get bills resolved faster because you contact only one place on your end.
So the answer to your situation is: do the doctors have your correct health coverage information (that you have Medicaid as well as Medicare) and do they accept that payment? If that's the case, then there is an error. Also Medicaid can be slow to pay at times, taking months to pay a bill even when there isn't a billing error.
I suppose that either A) the clinic does not have the Medicaid coverage on file. They don't know you have it. OR B) they don't accept Medicaid, which is their option
If you did inform them of your Medicaid coverage, they should have told you immediately that they don't accept it, if that is the case.
On community Medicaid you have to be referred to doctors who accept both Medicare and Medicaid. Otherwise, you will still be responsible for co-pays. It is a patient’s responsibility to make sure that the doctors they go to accept both Medicare and Medicaid.
To the best of my limited knowledge, you shouldn’t have to pay anything. People go on Medicaid because they have no money and can’t afford to pay, right? Call the billing department of these doctors who are sending you the bills and ask them why you are getting bills. When my mom had an $800 bill from her dentist, I told them she was on Medicaid, but they said they don’t accept Medicaid. Well, Mom didn’t have the $800 so basically the dentist got stuck. The only thing I can think of is some sort of silly deductible.
Keep a pen and paper handy and make notes of who you speak to at the billing department and what they say. Make sure they have all your information correct. We hit a glitch once when someone entered my husband’s wrong birthdate.
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 ConsumerFeedback@aplaceformom.com 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.
Medicaid will only kick in after all your financial savings are depleted to the required level, excluding a house, one car and a small amount of savings.
If your mother has too much in the bank or a stock account or anywhere else, she may have to spend down her money before medicaid will pay.
Medicaid has a 5 year look back. That means that she can not give money away or hide it in someone else's bank account to qualify for medicaid.
Not all physicians "participate" with Medicare, even if they accept the insurance. Some only accept certain Medicare Advantage plans. (For example, my family MD does not accept United Health or Humana Medicare plans.)
Are you receiving "Community Medicaid" or are you participating in a "Medicare Savings Program".
If, for instance, you are participating in the Qualified Medicare Beneficiary ("QMB") Medicare Savings Program, then Medicare providers are prohibited by Federal Law to charge the patient anything above Medicare's reimbursement and the state's Medicaid payment (if any) irrespective as to whether or not the provider participates in a given state's Medicaid program.
Background can be found here: www.ssa.gov/OP_Home/ssact/title19/1902.htm
But you may be better off calling Medicare (1-800-MEDICARE) to discuss your particular circumstances or search the Medicare.gov website for more information.
1.) Call the provider you are receiving bills from & ask them why they are billing you;
2.) Call Medicare & Medicaid and ask about the bills for co-pays;
3.) Make sure that the providers you see accept Medicaid.
Many providers no longer accept Medicaid for office visits & other services. If you want to go to doctors/providers that do not accept Medicaid, you will be responsible for 20% of the total amount billed.
My husband and I both are licensed clinical psychologists. I am also a licensed mental health evaluator. We both are registered Medicaid and Medicare practitioners. We have been able to stay in practice because we have other income sources. We used to receive $67.00 per billable hour reimbursement from Medicare and $59.00 from Medicaid. For a group session it was $13.00. It sounds like a lot of money, but it isn’t. From that amount one must pay for office space, taxes, supplies, continuing education training, utilities, Worker’s Comp, clerical support, computer equipment, billing software to meet reporting/billing requirements for insurance and government and licensing costs. And then the big thing, liability insurance for our office space -and ourselves. Every year the premium goes up. Congress wants nothing more than to cut back on Medicare and Medicaid. I only practice on a very limited basis. My husband works full time. He only has a limited number of Medicaid patients who are children and accepts no Medicare patients. He probably will stop accepting Medicaid in the fall. Reimbursements to practitioners at all levels are inadequate.
My advice would be to contact Medicare & Medicaid, starting with Medicaid.
When a hospital tried to bill me for a CAT-scan - I contacted Medicaid. They said to tell the hospital that they had already receive a Medicaid payment and as long as they had accepted it, I owed nothing. I never got another billing.
Everyone will try to collect whatever they can. But if they accept as much as $1 from Medicaid, you are not supposed to owe. Contact your Medicaid office - I was helped over the phone.
The kicker is, CAT-scans are not covered but the hospital had assured me when I arrived that it was covered. They billed it as some other, acceptable, test. Medicaid was hoping the hospital would pursue the issue and they would have taken the hospital to court. But the hospital backed down.
This is why you always must ask before you get any treatment. I even had to ask the Dentist before I went into the examination room.
Our local Office of the aging handles the Medicaid health insurance. Call them and ask if you can sit with someone who can explain how your medicaid healthcare works. Maybe some adjustment can be made.
Do they offer integrated Medciare-Medicaid plan options in your area? If you were to change to the integrated, it could help to get bills resolved faster because you contact only one place on your end.
So the answer to your situation is: do the doctors have your correct health coverage information (that you have Medicaid as well as Medicare) and do they accept that payment? If that's the case, then there is an error. Also Medicaid can be slow to pay at times, taking months to pay a bill even when there isn't a billing error.
A) the clinic does not have the Medicaid coverage on file. They don't know you have it. OR
B) they don't accept Medicaid, which is their option
If you did inform them of your Medicaid coverage, they should have told you immediately that they don't accept it, if that is the case.
Keep a pen and paper handy and make notes of who you speak to at the billing department and what they say. Make sure they have all your information correct. We hit a glitch once when someone entered my husband’s wrong birthdate.