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Old 06-12-2016, 01:42 PM   #21
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I wouldn't pay the bill either from the estate's funds or my own. The hospital is not following the Medicare and insurance co. rules that they agreed to. I suggest you simply ignore the bills from here on, or if you want to, call the hospital once in a while and try to get someone who knows what they're doing.

It's going to collections? So what! It is not a legitimate debt and the executor of the estate has no obligation to pay it. After a while they'll give up.
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Old 06-12-2016, 01:53 PM   #22
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pb4uski,
Under Medicare hospice care is handled differently. Original Medicare pays the agency. The hospice agency pays the hospital for the room. There was no problem there. The bill is for the ER and first night only. What a complicated system.
I'm just making an observation here: Sounds like your dad was enrolled in a Medicare Advantage plan rather than having traditional Medicare with an optional supplemental insurance plan (sometimes referred to as a Medigap policy).

The Medicare Advantage insurer should be responsible for the approval of services as they are the ones paying the providers, not Medicare or your dad.
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Old 06-12-2016, 03:11 PM   #23
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It looks to me as if the first night in the hospital your father was admitted "under observation", which Medicare will not reimburse...

In the case of a Medicare Advantage plan, however, the insurance company agreement with the hospital would prevail.
My condolences to the OP.

To clarify, original Medicare covers observation stays when the medical notes support it. Original Medicare does not cover a subsequent SNF stay after observation.

Medicare Under Observation
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Old 06-12-2016, 03:35 PM   #24
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The executor might tell the hospital the estate does not have enough money to pay all bills of this type. In such situations, other creditors, such as the state, have priority and the hospital might wind up with $0. They know this so will negotiate the bill way down. The executor can offer 10% up front and the hospital may accept. Get it in writing as such a document may be reviewed during probate.
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Old 06-12-2016, 03:53 PM   #25
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That all may be true, but if the estate was only a few thousand, and the $6,000 was a significant part of it, it falls into the category of unsecured debt. No hospital, or any creditor, will chase $6,000 from an estate that may not even be worthwhile. If it was $100K, and much of that goes through probate, then that maybe different. ....
The hospital has no way of knowing whether the estate is $6,000 or $60 or $6 million... all they know is that the estate owes them $6,000 (or so they think but it sounds like they are probably wrong on that). If you send them the death certificate it gives them no more information than they had before.
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Old 06-12-2016, 04:14 PM   #26
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The hospital has no way of knowing whether the estate is $6,000 or $60 or $6 million... all they know is that the estate owes them $6,000 (or so they think but it sounds like they are probably wrong on that). If you send them the death certificate it gives them no more information than they had before.
It gives them knowledge that their debtor is no longer producing income, and to chase the person is likely to result in no money. They will hesitate to throw good money after bad. With person that is still alive, they can get a judgement for little to no cost.

If they want to file a claim against the estate, they only have a limited time to do so, and that is likely to fail. Any account with a beneficiary is not required to go through probate. A probate claim is their only chance, or trying to convince someone to pay that may feel some guilt.

Even if they had a right to collect, they will not chase $6K from someone that was in a nursing home and likely has no assets.

These bills are on auto-pilot from the billing department. They need something to charge the bills off. A death certificate is what they need.
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Old 06-12-2016, 04:21 PM   #27
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This has sparked more interest than I would have anticipated and I appreciate all of the feedback. Please note that his status was not observation as evidenced by Aetna's denial based on not meeting the impatient criteria. It looks like Aetna would have liked him to be observation status. I have wondered if they were trying to avoid a new nursing home coverage event.

I'm not sure how to describe the estate. We are in Connecticut. My father had assets, all of which were financial accounts. Everything passed to me by beneficiary or joint ownership. However he was in a nursing home on self pay and the entire month of January was pre-paid. His last day in the home was Jan. 3rd. So of course the nursing home cut a check for over $11,000 payable to the estate of. And there was another smaller check payable to the estate from his LTC insurance. In CT if there is no real estate and the assets subject to probate are less than $40,000 you can do a small estate affidavit, which is what I did. I was not named executor and an estate account was not opened. I was given an order of distribution to pay the checks to me and after a review by their legal department which probably took 15 minutes while I waited the bank accepted them for deposit. (They had me endorse them "successor to XXX by court order".)
Anyway there is not an issue as far as sufficient money to pay his bills and it had always been my intention to quickly pay all legitimate bills. Its only this one that is a problem. So I am his sole heir, I handled his accounts before and after death, but there is no executor.
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Old 06-12-2016, 06:42 PM   #28
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Hang onto any money. Worse case, they take you to Court (which they won't), and you settle for 50% before the trial date.
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Old 06-12-2016, 07:08 PM   #29
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When my Ex died with zero assets I consulted an attorney about setting up an estate. (DS was age 26 and next of kin.). He told me it wasn't necessary to open an estate and if we got bills from the hospital or other creditors we should tell them they were free to open an estate and file a claim. We never heard from any creditors. I was in KS, DS lived in Iowa and the Ex died in FL. I mention this because it sounds like the hospital might have to open estate proceedings for your father to collect, in which case they may not bother.
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Old 06-12-2016, 07:13 PM   #30
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Why do you want to involve yourself in a Pi#$ing contest between the hospital and the insurance company? This is the reason all the rules and regs are so complicated to begin with.How is any layman supposed to know the rules when the companies themselves fight over them?

You Dad had Medicare and extra insurance coverage.I wouldn't give the hospital another thought.You can sent the hospital a letter outlining what your insurance told you and tell them to duke it out between them. Perhaps the hospital needs to recheck your DD charts and re code some of bills, not your problem.
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Old 06-12-2016, 07:14 PM   #31
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Why do you want to involve yourself in a Pi#$ing contest between the hospital and the insurance company? This is reason all the rules and regs are so complicated to begin with.How is any layman supposed to know the rules when the companies themselves fight over them?

You Dad had Medicare and extra insurance coverage.I wouldn't give the hospital another thought.You can sent the hospital a letter outlining what your insurance told you and tell them to duke it out between. Perhaps the hospital needs to recheck your DD charts and re code some of bills, not your problem.
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Old 06-20-2016, 04:41 PM   #32
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This has sparked more interest than I would have anticipated and I appreciate all of the feedback. Please note that his status was not observation as evidenced by Aetna's denial based on not meeting the impatient criteria. It looks like Aetna would have liked him to be observation status. I have wondered if they were trying to avoid a new nursing home coverage event.

I'm not sure how to describe the estate. We are in Connecticut. My father had assets, all of which were financial accounts. Everything passed to me by beneficiary or joint ownership. However he was in a nursing home on self pay and the entire month of January was pre-paid. His last day in the home was Jan. 3rd. So of course the nursing home cut a check for over $11,000 payable to the estate of. And there was another smaller check payable to the estate from his LTC insurance. In CT if there is no real estate and the assets subject to probate are less than $40,000 you can do a small estate affidavit, which is what I did. I was not named executor and an estate account was not opened. I was given an order of distribution to pay the checks to me and after a review by their legal department which probably took 15 minutes while I waited the bank accepted them for deposit. (They had me endorse them "successor to XXX by court order".)
Anyway there is not an issue as far as sufficient money to pay his bills and it had always been my intention to quickly pay all legitimate bills. Its only this one that is a problem. So I am his sole heir, I handled his accounts before and after death, but there is no executor.

A little off point but notwithstanding the majority of assets passed directly to you, and probate assets are less than $40,000, you still need to pay probate tax in CT. Wasn't clear if you did this step from the post so just an FYI.


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Old 06-21-2016, 04:35 AM   #33
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A little off point but notwithstanding the majority of assets passed directly to you, and probate assets are less than $40,000, you still need to pay probate tax in CT. Wasn't clear if you did this step from the post so just an FYI.


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Right, In CT all estates are required to go through probate court and file a state estate tax return. The probate court fee is based on the gross value of the estate even if there is no estate tax due.
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