Bel-Air Lodge Convalescent Hospital

Please review my complaint dated 2-2-Your email stated 2-25-in errorAlso note it took [redacted] two months to reply to your first contactThe first attorney I confronted said he was not familiar with Medicare billings and suggested I first try to resolve the problem with Mark One which I didI contacted [redacted] and gave her several photo copies of my Anthem Insurance which clearly shows $3,is the annual limit I am to pay for services my wife receivedAs stated in my complaint I tried several times to contact Pettapice for the $6,refund im due but was always told she was in a meeting put on voice mail and she never returned my callsIt seems she believes do nothing and the problem will go away but it just gets biggerI contacted my insurance again today to leave the status of Mark One billing which should have started at least in July I was told then finally received a partial billing and they are trying to get the additional information needed before they can make paymentThe CMS.Gov website refererred to does not show any cost figures but to believe Medicare would knowing pay over three time the actual daily rate of Bel Air services or to bill for those amounts is beyond reason in my opinion In the response you received for Mark One they said they had been cleared by the Department of Public HealthThat is not exactly trueMr [redacted] did not discuss her investigation with me but only said she could not substantiate the claimShe was either misguided, incompetent or for some other reason did not do a proper investigation in my opinionThe letter I received from her supervisor copy attached is filled with a lot of gobble de goop only refers to a misappropriation of Property which was never part of my complaint which was the same as filed with Revdex.comI told [redacted] that in a voice mail and have never heard back from himIt is just another case of "Do nothing and the problem will go away" It won't

Skilled Nursing Facilities except patients covered by Medicare Part A Insurance. We are required to show Medical necessity when billing for skilled care. Part A covers skilled
services of days. days at 100% and days have a co-insurance amount of $per day for year 2014. If patient no longer meets skilled need, or has plateaued in their progress, before they can exhaust their Medicare A coverage, the payer changes and either becomes private pay, Hospice private pay, Medi-cal, or Medi-cal Hospice. This is for room and board charges, not skilled services. We bill Medicare our allowed rate using the Prospective Payment System that can be explained on the CMS.Gov website. The Centers for Medicare and Medicaid Services. The Insurance Policy that was provided in this case will pick up coverage only after Medicare A benefits have exhausted, and this patient had not. Information provided by the complainant, was that an attorney had been consulted and said that we were not at fault. We have also been cleared by the California Department of Health Services after given our documentation. With no successful out come with this other insurance that was provided, resident has been referred back to deal with his insurance

Please review my complaint dated 2-2-15. Your email stated 2-25-15 in error. Also note it took [redacted] two months to reply to your first contact. The first attorney I confronted said he was not familiar with Medicare billings and suggested I first try to resolve the problem with Mark One which I did. I contacted [redacted] and gave her several photo copies of my Anthem Insurance which clearly shows $3,000 is the annual limit I am to pay for services my wife received. As stated in my complaint I tried several times to contact Pettapice for the $6,880 refund im due but was always told she was in a meeting put on voice mail and she never returned my calls. It seems she believes do nothing and the problem will go away but it just gets bigger. I contacted my insurance again today to leave the status of Mark One billing which should have started at least in July 2014. I was told then finally received a partial billing and they are trying to get the additional information needed before they can make payment. The CMS.Gov website refererred to does not show any cost figures but to believe Medicare would knowing pay over three time the actual daily rate of Bel Air services or to bill for those amounts is beyond reason in my opinion
In the response you received for Mark One they said they had been cleared by the Department of Public Health. That is not exactly true. Mr. [redacted] did not discuss her investigation with me but only said she could not substantiate the claim. She was either misguided, incompetent or for some other reason did not do a proper investigation in my opinion. The letter I received from her supervisor copy attached is filled with a lot of gobble de goop only refers to a misappropriation of Property which was never part of my complaint which was the same as filed with Revdex.com. I told [redacted] that in a voice mail and have never heard back from him. It is just another case of "Do nothing and the problem will go away" It won't.

Review: My wife [redacted] was a patient at Bel Air Lodge Convalescent Hospital in Turlock, CA. For 139 days. She passed away Oct. 14, 2014. When I put my wife in Bel Air I was told the Rate was $200 per day and I would be responsible for any amount Medicare and my insurance didn't pay. When I received copies of Medicare payments to mark one, owner of Bel Air, they Totaled $30,099.29. More than 139 days at $200 a day or $27,800.00. I have [redacted] insurance which limits my payment to $3000 per year of the care my wife recieved. Before I realized this I was billed and paid [redacted] One $9880.00. Several times I have phoned, ###-###-####, And asked for a refund of the overpayment but the office manager,

[redacted], is always at Lunch or in a meeting and does not return my voice mail messages. On 1-20-2015 I phoned my insurance [redacted], and asked the status of [redacted] billing. I was told they had never billed. They phoned [redacted] and gave them all the information they needed to bill. On 2-2-2015 I again phoned my insurance to learn the status of [redacted] bill.Desired Settlement: I phoned [redacted] but she was not available to take the call so I left her another voice mail and told her if I did not receive the refund check by one oclock I would file a complaint with Revdex.com. I did not receive a check or phone call.

I am enclosing information related to this complaint. [redacted]

Business

Response:

Skilled Nursing Facilities except patients covered by Medicare Part A Insurance. We are required to show Medical necessity when billing for skilled care. Part A covers skilled services of 100 days. 20 days at 100% and 80 days have a co-insurance amount of $152.00 per day for year 2014. If patient no longer meets skilled need, or has plateaued in their progress, before they can exhaust their Medicare A coverage, the payer changes and either becomes private pay, Hospice private pay, Medi-cal, or Medi-cal Hospice. This is for room and board charges, not skilled services. We bill Medicare our allowed rate using the Prospective Payment System that can be explained on the CMS.Gov website. The Centers for Medicare and Medicaid Services. The Insurance Policy that was provided in this case will pick up coverage only after Medicare A benefits have exhausted, and this patient had not. Information provided by the complainant, was that an attorney had been consulted and said that we were not at fault. We have also been cleared by the California Department of Health Services after given our documentation. With no successful out come with this other insurance that was provided, resident has been referred back to deal with his insurance.

Consumer

Response:

Please review my complaint dated 2-2-15. Your email stated 2-25-15 in error. Also note it took [redacted] two months to reply to your first contact. The first attorney I confronted said he was not familiar with Medicare billings and suggested I first try to resolve the problem with Mark One which I did. I contacted [redacted] and gave her several photo copies of my Anthem Insurance which clearly shows $3,000 is the annual limit I am to pay for services my wife received. As stated in my complaint I tried several times to contact Pettapice for the $6,880 refund im due but was always told she was in a meeting put on voice mail and she never returned my calls. It seems she believes do nothing and the problem will go away but it just gets bigger. I contacted my insurance again today to leave the status of Mark One billing which should have started at least in July 2014. I was told then finally received a partial billing and they are trying to get the additional information needed before they can make payment. The CMS.Gov website refererred to does not show any cost figures but to believe Medicare would knowing pay over three time the actual daily rate of Bel Air services or to bill for those amounts is beyond reason in my opinionIn the response you received for Mark One they said they had been cleared by the Department of Public Health. That is not exactly true. Mr. [redacted] did not discuss her investigation with me but only said she could not substantiate the claim. She was either misguided, incompetent or for some other reason did not do a proper investigation in my opinion. The letter I received from her supervisor copy attached is filled with a lot of gobble de goop only refers to a misappropriation of Property which was never part of my complaint which was the same as filed with Revdex.com. I told [redacted] that in a voice mail and have never heard back from him. It is just another case of "Do nothing and the problem will go away" It won't.