5 Hidden Traps in Nursing Home Billing to Avoid

The need to visit a nursing home facility can arise anytime. Whether it is for us, or for a loved one, choosing where to get admitted is a major decision. A very serious concern in this regard is cost. Nursing home billing, to be absolutely honest, is an expensive affair, and can quickly get escalated beyond comfortable limits.

It has been calculated that the median annual cost of a semi-private nursing home room in 2023 was $104,025 in 2023. But this is just the average, bare-bones cost. Allied expenses can inflate the figure quickly. Nursing home billing is a controlled sector, governed by strict regulations. But the probability of unexpected charges can never be completely obliterated.

In a bid to avoid financial surprises (or shocks, to be more precise), it is important to understand the full scope of potential fees.  

Here are five potholes to watch out for to avoid unpleasant surprises afterwards. 

• Health Assessment Fees

A large number of nursing homes conduct a health assessment when a patient moves in. While some facilities include this assessment in their standard care, others may charge a one-time fee for the evaluation. 

Steps to take: Before selecting a nursing home, ask whether the initial health assessment is included in the standard pricing or billed separately.

• Leave of Absence Fees

In the event of a resident temporarily leaving the facility for a hospital treatment or therapy, the nursing home may charge a ‘bed-hold’ fee to reserve their spot. Without a signed agreement, the facility has the right to assign the bed to another resident.

Steps to take: Ensure that all such agreements are part of the admission paperwork to secure the resident’s place. Such fees should also be reasonably sustainable for the patient.

• State Assessments

Some states impose additional nursing home assessments on residents who pay privately. This fee is typically not applicable for those using long-term care insurance.

Steps to take: If paying out-of-pocket, check whether your state has an additional nursing home billing assessment. The good news? This charge may qualify as a tax-deductible expense—consult a tax professional for guidance.

• Extra Services and Add-Ons

Many nursing homes offer additional services beyond basic care, such as therapy, financial management, or social services. While these can enhance the resident’s quality of life, they may come with added costs.

Steps to take: The simple measure to adopt is staying wary. You can always ask to see an interim bill, with itemized entries indicating the associated cost. It is also wise to have a clear picture of how your chosen facility defines ‘care’.

• Annual Cost Increases

Nursing homes frequently adjust their rates, often raising costs for room, board, and medical services annually. If you don’t monitor monthly statements, you might miss subtle but steady price hikes.

Steps to take: Before committing, ask how often the facility increases its fees. Regularly review pre-billing statements to catch changes and question any unexplained increases. 

The Final Word 

Understanding the rudiments of nursing home billing can go a long way in effectively avoiding unexpected financial surprises. Developing an appreciation of its caveats, can help you stay even better protected. As a rule of thumb, always review contracts carefully, ask for detailed pricing information, and stay vigilant about added fees. Your final bill need not be a nightmare, but an agreeable conclusion to your convalescence.