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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
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.
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
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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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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