By Dan Noll on May 17th, 2024 in Articles, Nursing Home Abuse
Experienced Nursing Home Abuse Lawyers Explain Who Pays for Bed Sore Treatment in a Nursing Home
Each year in the United States over 2.5 million people suffer from a bed sore. Also known as a pressure sore, pressure ulcer, or decubitus ulcer, this type of medical condition is generally considered a “never event.” This means that this condition should not occur in the presence of medical care and treatment that meets the acceptable standard of care. In order words, residents of a nursing home in Illinois should not develop bed sores if the nursing home, long-term care facility, or rehabilitation center provide competent care and treatment. Therefore, when a resident is diagnosed with a bed sore, it often means the resident is a victim of nursing home neglect, abuse, or negligence. Unfortunately, the experienced nursing home abuse lawyers at the Noll Law Office in Springfield know bed sores result in significant personal injuries and high medical costs. As a result, many families ask who pays for bed sore treatment in a nursing home in Illinois and how their families can get it covered.
Although nursing homes, insurance adjusters, and defense lawyers might not tell you the truth, the experienced legal team at the Noll Law Office will during a free case evaluation. That’s because the party who is often most responsible to pay for the costs of bed sore treatment and damages is often the party who shifts it to Medicare, another provider, or even pushes it to the victim and the victim’s family. This is unacceptable. If you or a loved one were diagnosed with a bed sore in Illinois, especially a stage 3 or a stage 4 bedsore, contact the Noll Law Office to schedule a case evaluation by dialing (217) 414-8889.
Determining Who Pays in Illinois Nursing Home Bed Sore Cases
There are many important steps and considerations when determining who pays for bed sore treatment in a nursing home in Illinois. That’s because payment depends on several factors, including:
- Where is a resident being treated?
- What insurance and medical coverage does a resident have?
- When did the bed sore develop?
- Where did the bed sore develop?
- Who is at fault?
- And other important factors that could dictate payment or treatment, which you should discuss with your nursing home abuse lawyer in Springfield.
Where is the Resident Being Treated?
In determining who pays for bed sore treatment in a nursing home, the most basic inquiry is where is the resident being treated. This is particularly important because most residents of a nursing home, long-term care facility, or rehabilitation center will qualify for Medicare. That ties into what insurance and medical coverage that a resident has available to him or her.
Therefore, Medicare Part A will pay for bed sore treatment when a resident is being treated for a bed sore in a nursing home. This includes if a resident is admitted into a hospital. Residents who have stage 4 bed sores may have significant injuries and may need to be transferred to that hospital too, which is a common complication. Some residents may want to be transferred and can have Medicare Part A also pay for home health care. When a resident is unlikely to survive the nursing home malpractice, hospice care will also pay for bed sore treatment and palliative care.
However, if a resident leaves a facility and is not admitted, bed sore treatment at a physician’s office will be paid by Medicare Part B. This is less common because a resident will likely continue with a home health care nurse or aide, but it is possible – especially for follow-up care and treatment from complications after a bed sore such as an infection or surgery.
Lastly, if a resident does not have Medicare, a resident’s private insurance may be responsible for paying for the care and treatment associated with a bed sore. If a resident does not have insurance, that could mean that he or she is responsible to pay for this treatment.
The When, Where, and Who Factors
Importantly, who pays for bed sore treatment in a nursing home in Illinois may also depend on the when, where, who factors. In fact, these factors could even dictate who is entirely responsible instead of Medicare or health insurance.
Specifically, when and where did a bed sore develop is important. If the bed sore developed while a resident was in a nursing home, that is a “never event” and makes it their responsibility. But if the bed sore occurred at a different facility or even a hospital that transfers a resident to a nursing home, it may be that other facility. Additionally, if the bed sore occurs at home before a resident seeks treatment, it may actually be the resident or the family’s responsibility – although there are exceptions to that if a resident was receiving in-home care or under the supervision of a doctor who missed the signs of a bed sore.
That leads to the question of who is at fault. If a resident develops a bed sore while in a nursing home or another type of health care facility, this “never event” generally means that it is the fault of that facility. Therefore, who pays for bed sore treatment in a nursing home may actually shift from Medicare to the facility itself due to its negligence. Of course, defendants do not explain this, which is why victims and their families need to hire an experienced nursing home abuse lawyer to help them uncover liability and hold defendants responsible under the law.
What Happens if Bed Sore Bills are Paid but a Nursing Home is Later Found Responsible?
A common scenario is where bed sore treatment is paid for by one insurer, like Medicare, but then a defendant is found liable. It may even be the case that a resident and his or her family pays for treatment first too, and then a defendant is found liable. In these situations, whoever paid is often entitled to reimbursement from the defendant.
When Medicare pays first, that means there will be a CMS lien that needs to get resolved and repaid. That will come from the proceeds of the settlement or verdict, and it is often the resident who is responsible to ensure those bills are reimbursed. However, most skilled lawyers will ensure that any payment includes money to reimburse those bills as well as a victim’s other damages such as pain and suffering. The process to resolve a CMS lien can be long, usually resulting in a back-and-forth between CMS and the victim’s lawyer, but it can often be reduced and paid without an issue.
Still Unsure Who Pays for Bed Sore Treatment in a Nursing Home? Call the Noll Law Office
If you or a loved one were diagnosed with a bed sore and required expensive and painful treatment, call the experienced nursing home abuse lawyers at the Noll Law Office. Bed sores are known as “never events,” and residents who suffer from bedsores are often entitled to compensation for their damages. To learn more about how to recover compensation to pay for bed sore treatment in Illinois, contact the fifth-generation lawyers at the Noll Law Office in Springfield, Illinois.