3 Steps to Your Admission
If you have scheduled an elective surgery or procedure and know the date of your hospitalization, we encourage you to complete the following steps prior to your surgery date:
Consult with your physician / care manager regarding your need for post acute care or short term rehabilitation.
Visit your 1st choice of the Premier facilities and complete a Guest Registration Application. In addition, you will need to provide a copy of your insurance cards, including any prescription drug insurance cards. Our experienced Guest Registration Team welcomes the opportunity to answer your questions. Please feel free to call us or stop by for a tour – appointments are preferred but are not necessary. The best time for a tour is between the hours of 9:00 am – 5:00 pm.
Upon admission to the hospital consult with your discharge planner or care manager regarding your choice of a Premier facility. Your discharge planner will review your plans for recovery and will schedule your transfer to the facility once your physician has written your discharge orders and all of the necessary hospital paperwork has been completed. You may need to provide at least three (3) choices of Premier facilities in the event your first choice facility is unavailable.
To begin the admission process at one of our Premier facilities, please contact the Guest Registration Department at the facility of your choice listed below:
ShorePointe Nursing Center
Evergreen Health and Living Center
West Bloomfield Nursing Center
Woodward Hills Nursing Center
Shelby Nursing Center
Health Insurance Coverage:
Our Premier Health Care Management communities accept a variety of health insurances. We also participate in the Medicare benefit program. While most expenses are covered, the final costs vary depending on your individual health care insurance program. Below is an outline of general information about the costs and insurance coverage for our rehabilitation programs.
What does my insurance cover?
Each insurance program has specific coverage benefits. While you are most welcome to inquire about coverage with our Guest Registration department, we strongly urge you to contact your individual insurance provider for an explanation of your specific benefits.
What is Medicare?
Below is pertinent information that applies to Traditional Medicare. Please note that there are additional Medicare insurance programs available to you that have different criteria than the Traditional plan listed below. We recommend that you contact your insurance company directly for a more detailed outline.
Traditional Medicare is a Federal Health Insurance Program for:
- People age 65 or older
- People under age 65 with certain disabilities
- People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant)
Traditional Medicare has FOUR Parts:
- Part A (Hospital Insurance) Most people don’t have to pay for Part A.
- Part B (Medical Insurance) Most people pay monthly for Part B.
- Part C (Medicare Advantage) Private fee for service/PFFS
- Part D (Prescription Drugs Coverage)
What qualifies me for Medicare benefits?
Medicare does not automatically cover nursing home care. In order to receive Traditional Medicare benefits in an extended care facility the following conditions must be met:
- You must have a minimum of a three (3) day in-patient hospital stay prior to admission.
- Admission to an extended care facility must take place within thirty (30) days of discharge from the hospital.
- You must meet the skilled care criteria as defined by Medicare.
- The maximum number of days that you may receive Medicare coverage for is 100 days. There is no guarantee that you will receive ALL 100 days. You must remain at a “skilled” level of care as defined by Medicare in order to receive their Medicare benefits.
What does “skilled” level of care mean?
“Skilled” care, as defined by Medicare, is care that requires the involvement of skilled nursing or rehabilitation on a DAILY basis. Skilled nursing and rehabilitation staff include: Registered and Licensed Practical Nurses, Physical and Occupational Therapists and Speech-Language Pathologists.
What does Medicare pay for? Are there any out of pocket expenses?
During an Eligible beneficiary’s stay in a skilled nursing facility, payment is as follows:
Traditional Medicare pays 100% of the bill for the first twenty (20) days. No secondary insurance is required (i.e., Blue Cross).
From the 21st day through the 100th day, there is a daily co-insurance rate. The co-insurance rate is adjusted yearly by Medicare. The co-insurance rate for the 2015 calendar year is $157.50. Medicare will pay the balance. Please note that your secondary insurance may cover this co-insurance. Again, we advise you to contact your insurance company directly for more information.
If your policy does not cover the daily co-insurance, then you are responsible for the payment. The facility will verify any secondary insurance to be sure that the coverage is active.
In the case where there is no co-insurance coverage, the Facility will require PRIVATE payment of the daily co-insurance rate. This amount will be due beginning on the 21st day of your Medicare benefit period. If you qualify for Medicaid assistance AND the facility participates in the State Medicaid Program, the co-insurance amount will be payable by Medicaid, however, your monthly patient pay amount will still be due.
Other out of pocket expenses not covered by ANY insurance include personal items such as: Beauty/Barber shop services, guest meals, rental of telephone or television and wheelchair van transportation.
Will my insurance pay for a private room?
Medicare will only pay for a private room if it is medically necessary. Otherwise, there would be an out of pocket cost for a private room.
What is Medicaid?
Medicaid is a State and Federally funded program that assists residents who are economically eligible pay for their nursing home costs.
For more information click (http://www.cms.hhs.gov/Medicaidgeninfo/)
Please be advised that you may still also be asked to pay a portion of the cost for your nursing home stay known as your patient pay amount which is determined by the Michigan Department of Community Health and based on your monthly income.
Click on the following link to review the state of Michigan Medicaid options for adults in long term care.
Which of your facilities accepts Medicaid?
All five (5) of our facilities participate in the Medicaid program:
- Evergreen Health and Living Center
- Shelby Nursing Center
- ShorePointe Nursing Center
- West Bloomfield Nursing Center
- Woodward Hills Nursing Center
Please note, there are a limited number of beds at each facility.
Long Term Care Insurance
In general, most long term care costs are paid for by the individual. If you have purchased a long term care insurance policy, while we will assist you in completing forms for reimbursement, please note that our contract is with you and not your insurance company. You are responsible for payment of facility charges. Your eventual reimbursement is between you and your insurance carrier.
What is Respite care?
Respite care is a short stay, usually 5 – 7 days. This program is available in our independent apartments, assisted living and nursing facilities. Respite care is helpful if you are a primary caregiver and would enjoy a break (respite) from the daily pressure of being a primary care giver.
Respite care Costs
Respite care costs depend on the level of care the guest may require. We encourage you to speak with the Guest Registration Department to review the individual options available.
What is Hospice Care?
Hospice care is “end of life care”. We have contracts with several providers in the local area and offer a peaceful environment and specially trained staff to assist in carrying out your Hospice plan of care. We understand that this is a very difficult time for all involved.
Our partner in care, Beaumont Health System, offers their Beaumont Hospice program. We encourage you to discuss your options with your physician.
Hospice Care (End of life Care) cost
There are FOUR levels of Hospice Care:
Level 1: Routine Hospice – there is no coverage for room and board. This is a private pay program. Hospice will cover the cost of medical supplies and medications for the Hospice diagnosis.
Level 2: Respite Hospice – Hospice will pay in full for up to 5 days (every 30 days) in a long term care setting.
Level 3: 5th Level Coverage – an insurance policy covers the cost of the room and care excluding personal items.
Level 4: Acute In Patient – this is a short term benefit that covers the cost for an acute episode related to your hospice diagnosis.