Payment & Billing Disputes in a Nursing Home

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Is your loved one being assessed extra charges in their nursing home that weren’t in the original contract? Nursing homes sometimes charge separately for various items and services including catheter supplies, diapers and other incontinence products, and wound dressings. These charges can be taxing and sometimes inappropriate and the nursing home does not expect you to know your rights regarding these kinds of charges. If you understand that you do not have to pay them, and why, you can challenge the nursing home and take the extra financial pressure off of your loved one.

These extra charges can be considered inappropriate for several reasons. If the resident is Medicaid or Medicare-eligible, the nursing home must accept payment from Medicaid or Medicare as payment in full and not expect anything else from the resident. The resident’s only financial obligation is to pay the deductibles and co-payments authorized by law. The charges can also be inappropriate if they were not authorized in the admission agreement, no matter if the resident is paying privately or with Medicare/Medicaid. The Nursing Home Reform Law requires that a nursing home notify the residents of any extra charges during the admissions process. The standard principles of contract law also apply here, requiring a nursing home to limit its charges to the amount authorized by the admission agreement.

There are two choices that you can make if your loved one is assessed extra charges. The riskier choice with more possible reward is to refuse to pay the unauthorized extra charges, with a written explanation to the nursing home that the admission agreement obligates the resident to only a pay a certain amount each month. The nursing home will likely accept the check with the amount agreed to and will take no action against the resident. It is possible that the nursing home may attempt to evict the resident for nonpayment, but the resident will often prevail because they can claim with justification that they have paid in full according to the contract. The less risky choice is to make a complaint to the state agency that inspects and licenses nursing homes. Ideally the state will order the nursing home to stop assessing extra charges, but they dislike ruling on financial matters so it might get put on the bottom of their list.

If your loved one is being assessed extra charges, it can put a strain on budget no matter how they are paying. If the nursing home will not accept the money agreed upon at the time of admission, you may need help navigating through this challenging situation. We have the experience to help you come out on top. Call Nursing Home Attorney Dan Pruitt today!

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