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TaxTom
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My mother is in a long term care facility inside a hospital.

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My mother is in a long term care facility inside a hospital. the insurance company says they will not pay because her policy says they will not pay if they are in a hospital . she is in the long term care part of the hospital. my friends love one was in the exact same place as my mother they kept telling them they were not going to pay but they started paying and paid every month. i do not understand how they can pay for theirs in the same place as my mother and not pay for my mother.
Submitted: 2 years ago.
Category: General
Expert:  TaxTom replied 2 years ago.

TaxTom :

Hello, Every insurance policy is different so even if your friends policy paid doesn't mean your mothers policy will pay. First get a copy of her insurance policy and go the hospitals financial assistance or billing department and they should able to look over the policy and see if your mother is covered, it may just be a matter on how the charges are coded that makes a difference. If the hospital says that you should be covered by the policy and your insurance company still refuses you would contact your state's department of insurance to make a complaint. Thanks Tom

Customer:

so even if they are in the same location how can they pay for one and not the other

TaxTom :

All insurance policies are different and coverages are different

Customer:

the thing that keeps bothering me is the fact that they kept telling them that they were not going to pay for their family member either and then they paid

TaxTom :

They maybe how the stay was coded, most policies will not pay for nursing home care unless is for rehabilitation and limit how many days they pay for hospital care. Is your mother old enough for medicare. Thanks Tom

Customer:

yes she has medicare but medicare will not pay for this

TaxTom :

Why is she requirted to stay in the hospital?

Customer:

that what the problem is . she is in A hospital but she is in a long term care bed that she can stay in for as long as she needs to she had a stroke and requires 24/7 care.she has nothing to do with the hospital .she is just like she in a nursing home.

TaxTom :

I understand, does the nursing home section of the hospital operate under a different name?

Customer:

no it is all the same and that is why the insurance will not pay because they keep telling me she is in a hospital

TaxTom :

We are back to where I started, the hospital since it is unique with a nursing home inside a hospital is should know how to handle the situatiuon. They will know how to bill the cost so that your policy covers the stay. It is how the bill is coded, if you visit their billing or financial assistance department they should be able to help you.

Customer:

i am sure when this policy was written there was no such thing as having long term care beds in a hospital but now it is. thank you for your help

TaxTom :

Your welcome

TaxTom, Internet Researcher
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Experience: Years of experience of finding questions for employeers, family and friends.
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