At a Glance: Insurance Information

Medicare:

Your costs in Original Medicare
During each benefit period under Medicare Part A for skilled nursing facility (SNF) care, your costs are structured as follows:

Days 1 - 20: $0. Medicare covers the full cost of SNF care for the first 20 days in each benefit period. (Note: If you're enrolled in a Medicare Advantage Plan, copayments may apply during these initial 20 days. Please check your plan for specific details.)

Days 21 - 100: There is a cost per day. From day 21 to day 100 of SNF care in a benefit period, Medicare requires a copayment. This copayment amount is determined each year. As of January 2024, the daily copayment amount is $204 per day.

After day 100: All costs. Medicare coverage for SNF care ends after day 100 in a benefit period. Any care required beyond this point is the responsibility of the patient.

Medicare typically covers stays only if the individual has been hospitalized for at least 3 nights within the past 30 days. However, some care communities participate in Accountable Care Organizations (ACOs), which may waive the requirement for a 3-night minimum hospital stay. In such cases, we collaborate directly with hospitals to determine if this exemption applies to patients and their families. We strive to keep patients and their families informed about any special considerations that may affect their situation. If you have questions about ACO participation or eligibility for waived hospital stay requirements, please feel free to discuss this with us. We are here to provide clarity and support throughout your care journey.

It's important to note that Medicare Part A limits SNF coverage to a maximum of 100 days per benefit period. This coverage resets when a new benefit period begins, typically after a break of 60 days without SNF care. If further SNF care is needed in a new benefit period, the coverage details and costs outlined above would apply again.

Understanding these costs and limits can help you plan and budget for potential SNF care needs under Medicare. If you have specific questions or need further clarification, please don't hesitate to reach out to us. We're here to assist you in navigating Medicare coverage and ensuring you receive the care you need.

Managed Care plans coverage overview and considerations:

Hospitalization Requirement: Some Managed Care plans do not necessitate a 3-day hospitalization for coverage, providing flexibility in admission criteria. We can verify your specific plan benefits and provide detailed information to ensure clarity.
Precertification Process: Managed Care plans typically require precertification, which involves a detailed assessment and approval process. Our dedicated case management team collaborates closely with hospitals to streamline this process on your behalf, minimizing any potential delays.

Recertification During Stay: Throughout your stay with us, Managed Care plans require periodic recertification. This ongoing assessment allows the Managed Care entity to monitor your progress and determine if additional care is necessary. This ensures that your care remains aligned with your evolving needs.

When an individual is receiving services through managed care, it's important to note that the managed care insurance plan holds the authority to make the final determination regarding a skilled nursing stay. They are responsible for issuing proper notice and providing appeal rights to the individual or their authorized representative. This ensures transparency and allows for a structured process in which individuals can understand decisions made about their care.

Plans are mandated to have a provider appeals process in place for members who face denials of prior authorization. Appeals categorized as "urgent" typically require resolution within 48 hours, while non-urgent appeals must be resolved within 10 calendar days.

During the appeal process, the provider interacts directly with a clinical peer appointed by the plan. This ensures that appeals are reviewed by a qualified healthcare professional who can assess the clinical aspects of the case impartially. This structured approach aims to address concerns swiftly and fairly, providing clarity and recourse for providers and members alike.

If you have encountered a denial of prior authorization and wish to appeal, please reach out to us. We are here to assist you in navigating the appeals process and advocating for the care you need.

We understand the importance of navigating Managed Care requirements smoothly. Our team is committed to facilitating this process and ensuring that you receive the necessary care and support. Please feel free to reach out with any questions or concerns regarding your Managed Care coverage. We're here to assist you every step of the way.

Private Pay:

For those opting to pay privately, we offer different daily rates depending on the type of room chosen. As a standard practice, we require an initial upfront payment upon admission. Our team ensures transparency by providing a detailed overview of the costs involved, helping you understand what to expect throughout your stay. This approach aims to provide clarity and peace of mind, ensuring that your loved one receives the highest standard of care in a comfortable and supportive environment. We are here to assist you every step of the way.

Medicaid:

If you qualify for Ohio Medicaid, your income will undergo a review to assess how much, if any, will be allocated towards covering your care expenses. Typically, your income will contribute towards nursing home costs, with Medicaid covering the remaining balance. In such cases, you will still be responsible for paying health care premiums and will receive a personal needs allowance.

If you have a spouse or other dependents residing in the community, they may also receive an allowance. This approach ensures that you receive necessary care while considering the financial needs of your family members. For further details on Medicaid eligibility and allowances, please feel free to contact us. We are here to provide assistance and guidance throughout this process.

We understand navigating insurance and payment options can be complex. Please feel free to reach out to us with any questions or concerns. We're here to support you through this process and ensure the best possible care for your loved one.

Dining Services

The love of food is one of the universal languages that enriches our lives. Our dining experience offers delicious, medically appropriate, and nutritious meals, fostering a sense of community as we gather around the table.

Each day, we present a variety of meal options, with an always-available menu for those who desire something different.

We are delighted to accommodate families who wish to share a meal with their loved one for a small fee. Additionally, we offer private dining spaces for family gatherings and celebrations, ensuring that you and your loved one can enjoy all the comforts of home through our dining experience.

Internet Access & Visiting Hours

In our warm and welcoming communities, we embrace visitors at any hour of the day or night, ensuring you can always share precious moments with your loved ones. For safety and peace of mind, our exterior doors secure at designated times, but our attentive staff is always on hand to grant you entry with a simple call.

We invite residents and guests to enjoy the convenience of complimentary guest Wi-Fi, allowing you to stay connected and share your experiences seamlessly.

Pet Policy

Pets are welcome to visit during your stay! Regulations are in place for safety and wellbeing. Pets must be well behaved, up to date on vaccinations and able to provide proof of vaccinations. It is recommended to call to discuss our pet policy prior to your visit.

Business Office Hours & Financial Questions

The business office manager at the community serves as a dedicated resource for addressing a wide range of financial questions that residents and their families may have. They are well-equipped to provide assistance with Medicare, insurance coverage, private pay rates, long-term care policies and Medicaid.

Their expertise ensures that individuals receive personalized guidance and support navigating these important financial matters. Whether it’s understanding benefits, exploring payment options or clarifying policies, they are committed to ensuring clarity and peace of mind for everyone involved.

You can reach out to them during typical business hours, from 8 a.m. to 5 p.m. and they will be happy to assist you.

Laundry Services, Maintenance, Housekeeping

Maintaining a clean and comfortable environment is crucial for our residents’ well-being. Our comprehensive laundry services ensure fresh, hygienic clothing and linens daily. Our laundry team handles every item with care, providing high-quality personalized services.

Our efficient pick-up and delivery schedule provides residents with the comfort of fresh laundry without the hassle. Trust our long-term care facility to provide top-notch laundry services, ensuring cleanliness and comfort for your loved one.

Maintenance Services

At HCF, we prioritize maintaining a safe, comfortable and inviting environment for our residents. Our comprehensive maintenance service includes:

• Facility Infrastructure: Regular upkeep of electrical, plumbing, HVAC systems and structural integrity.
• Groundskeeping: Well-maintained gardens, walking paths and outdoor areas.
• Housekeeping: Thorough cleaning of living spaces and common areas.
• Safety and Security: Secure entry points, surveillance systems and emergency protocols.
• Equipment Maintenance: Ensuring medical equipment and furniture are in optima condition.
• Resident satisfaction: Promoting a supportive atmosphere for enhanced quality of life.

Transportation for Appointments

At Shawnee Manor, we prioritize convenience and care for our residents. We actively encourage family members to assist with transportation to and from appointments, fostering a supportive environment. In addition to family support, we collaborate with dedicated transportation vans and other trusted transport companies to ensure flexibility and availability for outings and appointments. Please reach out to our team for more details on how we can accommodate your loved one’s transportation needs.