Responsible For Mother's Medical Bills?

[Holly Golightly]

What is the name of your state? California

14 months ago, my mother fractured her shoulder and wrist and after surgery, needed to be in a convelescent hospital for 3 months. I was informed that Medicare pays for up to 100 days of convelescent home care each year. She was only there for 90 days. Plus, she has a secondary insurance company (Cigna).

As she currently resides at a board and care facility due to mild dementia, I pay her bills. She recently received a bill from the convelescent center for $5,000+ with a one-line description "Other". I also noted on an EOB they billed Medicare and her other insurance $1,600 for "Speech Therapy" - which she didn't need for a fractured shoulder! By the way, Cigna refused to pay ANY of the bill.

My mother only has $6,000 to her name. She needs that money to live on, after she uses her social security check to pay for rent and medications. Can the facility come after her life savings (all $6,000 of it?)

Can they come after me, since they know my address?

Thanks for your advice.

[averad]

1-800-med-icare

Why didn't medicare pay?
What do the explination of benifits say? (Both Cigna and Medicare)
When you called the facility for a description on the $5,000 Other charge what did they say?

Something doesn't seem right with this billing, I have a feeling that the facility didnt break out the charges and it was rejected for an itamized billing. However because I dont have the eobs or any information other then what you have provided I can't be sure.

Your mother can be put into collections and sued.

[Holly Golightly]

Actually, Medicare paid $13,000 of a $16,000 bill. (That was only for one of the months she was there). Cigna didn't pay - and their EOB states they have contacted the facility for clarification on the bill but have not received a response - for 14 months...

I didn't receive the EOB's from Medicare as they won't change my mother's address without me personally going to the SS office with a doctor's note as to my mother's mental condition. (I didn't even know that until last Friday when I called Medicare to report the facility for the $1600 bogus speech therapy bill). So, I don't know the reason for Medicare not paying the whole balance.

As for my mother being sued or put into collections - I really don't worry too much about her credit rating. It's not like she's going to make any big purchases in the near future. As for the $5,000 balance - that facility which gave her a bedsore and had to be harassed into brushing her dentures - can pound sand as far as I'm concerned.

Thanks for your advice.

[averad]

Originally Posted by Holly Golightly

Cigna didn't pay - and their EOB states they have contacted the facility for clarification on the bill but have not received a response - for 14 months...

If you receive an eob that states they are researching a claim and its been 14 months (If its been 5 months you should be freaking out) you get on your phone every day with the Insurance and the Facility.

You need to call the facility and request an itemized billing for the claim Cigna rejected, if that returns nothing get on the phone with Cigna and request a conference call with the Provider_s billing department so it can be call recorded. If Cigna refuses to make a outbound call get a supervisor on the phone.

Medicare will not release information to you unless your mother calls and says its ok then hands you the phone. However Cigna needs the medicare EOB to process their claim so you could try calling them and ask for the rejection code medicare used.

As for the eobs going to your mothers address someone is collecting the mail get it from them.