When a few weeks were left prior to the 100 day mark of Mother’s skilled nursing stay, a care meeting was called to discuss her future plans. It was during this meeting that I learned the real truth about the financial end of long term care.
In a previous blog, I discussed average costs of long term care. (average in the State of Texas for the rate to be $140/day + extras) I was told that for her to stay in this facility, she would go on self-pay after 100 days at a rate of $165/day + extras. For a 30 day month, that comes to $4950 + extras. I was a bit relieved to hear that number, because I had seen the statements from the insurance company and the figures they were charged were immensely higher. Below is the actual amounts from the statements:
May 2016 – Medicare was billed $26,706.15 by the skilled nursing facility. That is the amount they paid, less a deductible from Mom’s secondary insurance (about $4400). During the month of May, Medicare was also charged for a doctor’s visit from three different doctors for $280-$336/ea. Medicare paid a very reduced amount in the range of $160 to each doctor. Medicare was also charge for 9 visits by a nurse practitioner for $270/ea, of which they would actually pay about $116/ea.
June 2016 – Medicare was billed $24,998.29 by the facility and they paid that less a smaller deductible from the secondary insurance. The doctor charged for 2 visits this month, 11 visits by the nurse practitioner, and 4 other services/doctors billed Medicare for the same numbers of the previous month per visit.
July 1-19 – Medicare was billed $15,606.06 by the facility. There were no doctors visits, but 7 charges by the nurse practitioner. Two additional charges by other services.
When I asked the administrator of the skilled nursing facility why the rates were over $800/day previously, she was stunned that I knew this information. She replied, “We charge the maximum amount that Medicare will pay.” You are probably asking, “What difference in care do you get for $165/day versus $800?” If you haven’t read my blogs from day 3 and 4, I will tell in brief – not much!
I have probably looked at those reports 4-5 times in the last few months and I get just as angry every time! Mom was not getting proper care in numerous ways during that time and had to eventually be hospitalized to recover from her ailments. She supposedly was visited and treated by a doctor and nurse practitioner several times each month and she was not getting better. I did meet the doctor one day when Mother was so ill and asked her if she had actually examined Mother. She told me, “No.” She had just observed her progress during a therapy session. I asked her to please physically examine Mother and she said she would. She told me to ask the nurse’s desk a few days later for doctor’s notes on her findings. I did and the nurse told me that there were no doctor’s notes of an exam – just orders that Mother needed to be changed every 4 hours.
I also tried to call the nurse practitioner from the phone number listed on the insurance documents. It was not a working number. I tried googling her name and could not find any office for her. I asked the nurses about this nurse practitioner and was told she comes in really early (before her office hours) to visit patients. Often before 7 a.m. I found that odd, since there was no office that I could find for her. I asked them for her phone number and was told that they don’t give out that information, but they would give her a message to call me. I never once received a phone call from this woman who was charging Medicare and insurance for 10 visits a month!
I am not suggesting that all skilled nursing facilities are bad. Many are not though and that is the truth of the matter. If you plan on putting a loved one into a place like this (or yourself), it is crucial that you have good insurance and a trusted family member who can look out for your best interest. Ask the hard questions and be persistent. There are agencies that can help, if you have problems. DADS with the State of Texas is one. There are also ombudsmen with the city in which your facility is located that can help mediate.