Knowing Your Insurance
by Jessica Luckett
Business Office Coordinator
Arlington Court Skilled Nursing & Rehab
Every Insurance is Different
The four main types of insurance are Medicare, Managed Medicare, commercial plans and Medicaid plans. Every plan is different when it comes to skilled nursing facilities. If it is a managed Medicare or straight Medicare, there is usually a copay starting on day 21 unless you have a secondary. Most secondary insurances should cover all or a big portion of the copay. Some managed Medicare plans will cover everything at 100%. Commercial plans will usually have a copay starting on day 1 unless you have met your maximum out of pocket. With these insurance plans, it is helpful to know your insurance so that when you come into a skilled nursing facility; you will not be surprised by a copay. The copays do vary depending in if you are in network or out of network with the facility.
With Medicare and Managed Medicare plans, if the plan wants to cut them from insurance because the patient is either doing too well or plateauing then the plan has to give at least 48 hrs. This time will provide you time to file an appeal or set up discharge planning. A third party then reviews the case and makes a decision.
Commercial plans do not have to give you any kind of notice. They may want you out by the next day. There is not a lot of time to get a peer to peer (our doctor and the insurance’s doctor) to be done. This can put a lot of stress on families as well if proper discharge planning has not been started.
Medicaid plans normally do not cut unless they feel the patient is ready to go home. These plans normally give a few day notice to help with setting up discharge but not always.
It is helpful for the patient or family member to be well-versed with the plan holder’s insurance benefits. This will save a lot of stress and potentially unforeseen costs. Starting discharge planning on day 1 of a skilled nursing stay can help for whenever the insurance decides to cut. There are several great team members at Arlington Court that are familiar with different insurance plans and can answer any questions that a patient or family member may have while they are staying at the center or before a potential stay. Reach the team at Arlington Court by call 614-451-5677.