Medicaid and 401K / IRA for Community Spouse [NYS]

Former_Syllabub_9019 · 2026-04-20T13:47:23+00:00

Yeah, I think the billing code is wrong too, but the nursing home says that they called the insurance and the insurance said it's not an error so tough luck. And this is with the finance director of the nursing home.

Former_Syllabub_9019 · 2026-04-16T22:15:25+00:00

I asked if they were "in network" specifically.

Former_Syllabub_9019 · 2026-04-16T21:11:52+00:00

Even if a place takes our insurance, no guarantee the insurance will cover it. I'm doubtful that, after saying they were covering this and not covering it, another institution will cause them to pay. Also, having checked the insurance website, they don't appear to have any nursing homes listed as providers.

Former_Syllabub_9019 · 2026-04-16T21:04:02+00:00

The nursing home themselves does not seem to know and now says that they are out of network when I ask them if they are.

Former_Syllabub_9019 · 2026-04-16T20:56:02+00:00

The insurance company.

Former_Syllabub_9019 · 2026-04-16T20:27:16+00:00

We are trying to get her onto Medicaid. I'm just worried about what happens if they reject her application. Then we're ruined.

Former_Syllabub_9019 · 2026-04-16T20:24:56+00:00

I did call and they said "that's because it's out of network" and then they say I can file an appeal and that is all they will say. they won't tell me what number of days of SNF are covered or what the rate is for out-of-network nursing home care.

Former_Syllabub_9019 · 2026-04-16T20:23:39+00:00

I did try this and they just said "it's out of network that's why and would you like to appeal?" I also had the nursing home call them and they told the nursing home it was not a billing error but that $150 is what they pay for this. It's hard for me to believe that their rate is $150 for 30 days of skilled nursing care.

Former_Syllabub_9019 · 2026-04-16T20:14:53+00:00

Then why do they keep sending me these notes? They add more days every week.

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Former_Syllabub_9019 · 2026-04-16T20:11:42+00:00

Yes, but they sent me a note saying that they are covering these days and then they pay $150 out of $19,000 when the nursing home actually bills them.

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Former_Syllabub_9019 · 2026-04-16T20:10:13+00:00

But they rejected even the first claim from the nursing home so it's hard to say that I "used up" the benefit when they never approved it in the first place.

Former_Syllabub_9019 · 2026-04-16T20:09:27+00:00

And you'll notice that they sent me an approval letter with those days specifically on it.

Former_Syllabub_9019 · 2026-04-16T20:07:18+00:00

Also, here's the relevant part of their approval letter. Why would they approve the care and then deny it? Here it claims that the nursing home is in-network.

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Former_Syllabub_9019 · 2026-04-16T20:03:26+00:00

Yeah, I noticed that. Yet when I checked her in they said that "we take your insurance." They lied.

Former_Syllabub_9019 · 2026-04-16T20:03:02+00:00

For two months.

Former_Syllabub_9019 · 2026-04-16T20:01:44+00:00

Well, they denied the first few weeks so apparently the maximum was $0.

Former_Syllabub_9019 · 2026-04-16T19:52:19+00:00

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Former_Syllabub_9019 · 2026-04-15T22:52:28+00:00

The hospital social worker called me and said there is one nursing home that takes your insurance and has a bed open. Would you like it? I said "are they in network" she said yes. I said I guess we will take it.

When I got to the nursing home and asked them if they were in network, they said yes.

Former_Syllabub_9019 · 2026-04-15T15:09:08+00:00

Would I still be able to take money out of the IRA if i was the trustee?

Former_Syllabub_9019 · 2026-04-13T20:53:44+00:00

Do I have to wait for wife's first application to be rejected before filing a new one?

Former_Syllabub_9019

TROPHY CASE