Ceres, CA asked in Insurance Bad Faith and Insurance Defense for California

Q: Is a nursing home allowed to make changes to a residents insurance to meet the needs of the facility without consent?

A nursing home has made changes to my mom's insurance. My mom had Medicaid through the state of CA which was Health plan of San Joaquin. As of April 2020 , HPSJ was dropped and now she only has Straight Medicaid. I only found out after receiving bills from her Doctors telling me She owed for services. After contacting her health plan I found out that the facility changed it on my mom's request. Which is not possible since my mom is unable to comprehend this kind of information due to a stroke in Jan 2020. Is this legal can they make these changes without notifying me?

1 Lawyer Answer
William John Light
William John Light
  • Insurance Claims Lawyer
  • Riverside, CA
  • Licensed in California

A: Any answer to this question would require a lot more information: medical records of your mom's condition in April 2020, documents showing the Home's authority to act on your mom's behalf, documents from HPSJ showing how the change in service was accomplished, research showing whether this change somehow benefitted the home, and more. You may wish to contact your local DA's office in regards to possible financial Elder Abuse, and an Elder Abuse attorney.

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