What med sup extends skilled nursing after the 101st day that Medicare covers

[junkman]

Another agent brought me a page out of a supplement contract that says

"After you've used all 100 days of Skilled Nursing
Facility Services available under Medicare, the plan pays 80% of your remaining charges for Skilled Nursing Facilities".

It goes on to say that up to an additional 265 days are covered in a benefit period and the same requirements as Medicare has for the 1st 100 days must be met. I don't have a history with Medicare so am not familiar with earlier plan designs.

 

[Chazm]

It must be before my time as an agent. But before they were standardized any compmany could have done it I guess. I wouldn’t worry about it

 

[goillini52]

Another agent brought me a page out of a supplement contract that says

"After you've used all 100 days of Skilled Nursing
Facility Services available under Medicare, the plan pays 80% of your remaining charges for Skilled Nursing Facilities".

It goes on to say that up to an additional 265 days are covered in a benefit period and the same requirements as Medicare has for the 1st 100 days must be met. I don't have a history with Medicare so am not familiar with earlier plan designs.

Like Chaz said, that would have to be VERY old and before the Med Supps were Standardized. What company was it?

 

[junkman]

Carriers denied claim saying wasn't medically necessary. I'm trying to get them paid and wanted to make sure my understanding was correct. Apparently it is.

 

[goillini52]

Carriers denied claim saying wasn't medically necessary. I'm trying to get them paid and wanted to make sure my understanding was correct. Apparently it is.

What company was it? Sounds like Medicare didn't approve the claim? Were they in the hospital before the SNF? Were they admitted to the hospital, or were they in under "Observation Days"?

 

[junkman]

What company was it? Sounds like Medicare didn't approve the claim? Were they in the hospital before the SNF? Were they admitted to the hospital, or were they in under "Observation Days"?

This is Farm Bureau. Medicare approved the claim up to the 100 day limit. The contract calls for up to 265 more days past the Medicare 100 but the same criteria (in the hospital (she was) medically necessary etc)) must be met. The carrier is saying the stay wasn't medically necessary. Procedure code is AAAOO.

She couldn't do several of the ADLs, needed wound care and was being treated for pneumonia. Patient is upwards of age 95.

 

[goillini52]

This is Farm Bureau. Medicare approved the claim up to the 100 day limit. The contract calls for up to 265 more days past the Medicare 100 but the same criteria (in the hospital (she was) medically necessary etc)) must be met. The carrier is saying the stay wasn't medically necessary. Procedure code is AAAOO.

She couldn't do several of the ADLs, needed wound care and was being treated for pneumonia. Patient is upwards of age 95.

I'd have the Nursing Home try rebilling it. Providers screw up the codes all the time. Tell them that the insurance company's saying it wasn't medically necessary.

Also, check and make sure that the days past 100 are being billed as skilled care, because that's the only care that's covered by a Med Supp.