Paying for the Care you Need

It Starts with a Phone Call

Seasons Health and Rehabilitation is dedicated to making the transition to a skilled nursing facility as easy as possible. Rest assured that we will do everything we can to ensure that your loved one feels welcomed and comfortable. Call us at 435-628-1601.

Our admissions coordinator, Sarah Kelley, and our billing specialist, Tawndi Barrett, are here to answer any questions that you might have about cost, coverage and payments.

Ask Sarah about:

  • Addressing admission questions
  • Working with Social workers, doctors and hospitals
  • Questions about insurance including Medicare and Medicaid
  • Aligning discharges and making sure that Home Healthcare is received if a resident returns to their home
  • Solving problems or concerns for residences and their families

Ask Tawndi about:

  • Computing balances
  • Recording billing payments
  • Compiling account statements
  • Billing Medicare and Medicaid
  • Check insurances for admissions and therapies
  • Collecting card payments
  • Maintaining up-to-date records of the patient’s demographics
  • Process bills for third party insurances

Important Facts About Medicare and Medicaid

There are several ways to pay for your stay and care. These include Medicare, Medicaid, long-term care insurance policies, veterans benefits, and private funding. Initially, many nursing home facilities are covered by Medicare, after which your options are long-term care insurance policies, private payment, or Medicaid or a combination of all. You should carefully read the description of all available reimbursements. You can refer to the back of your insurance card for a customer service number to get assistance specific to your provider.

Medicare

Medicare is the federally administered health insurance program for people sixty-five years of age and older, certain disabled people under sixty-five years of age, and people with end-stage renal disease.

What you can expect from Medicare

  • The first 20 days are covered in any Medicare-approved skilled nursing facility.
  • For the days 21 through 100, Medicare will pay all covered services but is not automatically granted under the Medicare system.
  • Doctors’ visits
  • Nursing care
  • Semi-private room rates
  • All meals (including special diets)
  • Physical, occupational and speech therapies
  • Lab and X-ray services
  • Prosthetic devices
  • Prescription drugs
  • Some medical supplies and equipment

Conditions and Limitations

  • Medicare has strict coverage limitations for skilled nursing facilities.
  • Not including the day of discharge, the beneficiary must be in the hospital for 3 continuous days
  • An individual must be admitted to the nursing facility within 30 days of their hospital discharge.
  • Treatment must be similar nature to that which was treated at the hospital.
  • Daily nursing or rehabilitation services are required.
  • There must be a determination that only inpatient services will be sufficient.
  • In addition to a doctor specifying daily nursing services, they must also re-certify at intervals of 5 days and 14 days after admission. Additionally, the doctor must re-certify the need for daily nursing services every 30 days thereafter.
  • In addition to Doctor recertification of the need for services, Medicare will also have to review and approve the need for nursing services.
  • Lastly, they must be in nursing care for 100 days or less, and Medicare will also have to approve the length of stay. A 100 day stay is not automatically granted under the Medicare system.

Medicaid

Participants using the Medicaid service must pay a portion of their nursing care costs with any Social Security benefits they receive.

What Is Covered?

In most cases, an individual would need assistance with at least two activities and Medicaid would cover all the costs of nursing and medical equipment that a doctor may deem necessary. In addition, Medicaid will cover the holding of a bed for a  select amount of time, usually–a one to two-week period if a resident is requiring temporary hospital care. Also, to allow visits with family or friends, an absence of 18 days per year is covered.

 

Other Financial Sources

Personal or family money

Assets like stocks and savings, plus income from a job or investments. At the time of admission, residents paying privately must pay the daily rate from the day of admission through the end of the first month. Upon discharge, any credit balance on your account, after all pay sources are satisfied, will be refunded.

Pensions and Social Security retirement benefits

The primary income source for many seniors that can cover rent or mortgage payments.

Supplemental Security Income (SSI) 

Monthly public assistance checks for seniors and the disabled who have very limited income and assets.

Reverse mortgage

Can be an income source to pay for services to keep a senior in their own home, or to pay for nursing home care of a very ill spouse, or even pay furlong-term care insurance.

Long-term-care insurance

Sometimes pays only for nursing home care, but some policies cover an array of services in a private home or in an assisted living type of facility.

Contact us

Ask a question  •  Take a virtual Tour  •  Get a Brochure

435 628 1601

242 North 200 West
St. George UT 84770

office@seasonshealthgroup.com