Follow
Share

(Medi-Cal, in California) Mom was in the hospital for 6 days, then back to the SNF for a day, then back to the hospital for a week. Will Medi-Cal pay the SNF in full for the month? Do we pay the Share of Cost in full for the month?

My mother fell broke an ankle, hospitalized and SNF, ( over a month stay both) some months later she fell and broke a hip ( repeat scenario) third time she suffered an aeortic aneurysm rupture, ( repeat) She had Medicaid/ and a basic advantage plan. While in the first snf, I was prompted to " Upgrade her to a better plan. At leaving the snf they demanded a pymt ( copay) they said. We didnt question it at the time. Her second incident the snf demanded a 3k pymt. I called the insurance and they said " Absolutely Not! You're mother is QMB, qualified Medicare Benefciary. To not drag this out, the second 2 Snf's got nasty, left vm's and mailings, threatened me with " Missappropriation of my mothers funds, I am POA, and for nearly a year I battled the ordeal between 2 snf's. Insurance and various cust service reps ( turnover etc.) helping, wavering, doing nothing for a time, tho the QMB status was something I verified with Medicare as well and how it worked, NO co pays or pymt of any kind thru this medicare/ medicaid status. I FINALLY got a hold of an insurance rep who by the grace of God got thru to the otherwise UNREACHABLE admin people, put us on a 3 way call. The last home administrators had the nerve to tell me she had no idea why we were being harassed.
( her name all-over the mailings mind you) gave me an insincere apology, I expressed a few thoughts told her I HAD NEVER EVER hear from her business AGAIN. No mam, sorry Mam" and that was that. Sorry for the long story. Im not sure if I can use company names but H is who helped us thru this most difficult time.. QMB. Best wishes and Good luck
Helpful Answer (0)
Reply to Littlewing65
Report

I'm not a CA resident but I put your question into ChatGPT* and here is a synopsis:

Does SNF get paid for full month? No
Paid during hospital days?No
Paid when resident returns? Yes
Is Share of Cost still owed for full month? Yes (typically)I
s SOC prorated? No

Summary:
- SNF is paid only for days the resident is there
- Hospital gets paid for hospital days
- The resident still owes the full monthly Share of Cost

*ChatGPT can make mistakes. Check important info.
Helpful Answer (0)
Reply to Geaton777
Report

Ask a Question
Subscribe to
Our Newsletter