Do I Have to Pay This Bill?

“…in this world nothing can be said to be certain, except death and taxes.” To this list of life’s certainties attributed to Benjamin Franklin, we might also add bills. While the season of gift catalogs and holiday greetings is nearly upon us, our mailboxes are perennially filled with notices of balances due from utility companies, credit card providers, and medical offices, among many others.

When it comes to medical bills, there is often confusion about what we are responsible to pay, what should be covered by insurance, Medicare or supplemental Medicare plans, and whether other arrangements can be made.

Care Answered works with our clients before they have a medical encounter to ensure that planned services and providers will be covered by their insurance.  If you receive an unexpected bill after services are rendered by a healthcare provider, our best advice is to not automatically pay it before asking a few questions.

If you believe you received a bill for a medical encounter that should have been covered by insurance, contact your insurance provider and ask them specifically why they did not pay it. If the services provided are unclear, call the provider and ask for a detailed, itemized bill. If something listed on your bill is unclear to you, ask what it is.

Long-term skilled nursing facilities (A.K.A. nursing homes) should not bill patients who are covered by Medicaid. If your loved one has been approved for nursing home Medicaid and you receive a bill for their care, you may not be responsible to pay it.

Bills are generated by people working in billing departments; they are human and sometimes make mistakes so it always pays to check your bills carefully. If you feel you need an advocate because the billing seems wrong or if you want to make sure you don’t get charged before you go, contact Care Answered or call us at (516) 584-2007.

Untangling healthcare bills can be daunting, especially when you should be focusing on getting better.  We can help.

GuildNet MLTC Closure Update

The New York State Department of Health has affirmed that GuildNet will close as a Managed Long Term Care (MLTC) provider as of January 1, 2019. GuildNet had already ceased MLTC operations on Long Island, so this change primarily affects those in the boroughs of New York City and other parts of the state.

Current GuildNet MLTC clients need to be assessed and select a new MLTC company by December 18, 2018. Please note: if you would like to keep your current home care agency, an MLTC that has a contract with that home care agency MUST be selected.

The new MLTC is required by the state to do the following:

  • Continue to provide services under the enrollee´s existing plan of care, and utilize existing providers, for the earlier of the following: (i) one hundred twenty (120) days after enrollment; or (ii) until the new plan has conducted an assessment and the enrollee has agreed to the new plan of care.
  • Conduct an assessment within 30 days of the transfer enrollment effective date, unless a longer time frame has been expressly authorized by the Department at its sole discretion.

The new MLTC will conduct a new assessment and may recommend changes to the patient’s plan of care. Keep in mind that if you would like to change your new MLTC for any reason (for example, if they want to reduce hours of care), you MUST make that change within the first 90 days.

Click here for additional information: http://www.wnylc.com/health/news/78/

This process can be confusing and overwhelming. Contact Care Answered at 516-584-2007 with any questions or for help selecting a new MLTC agency.