Hello,
My mother is in her late 80's and unable to care for herself. She was fortunate enough to secure a full-time nurse, through her health insurance.
The total cost for the nurse is around $160,000/ year. The insurance company covers 80% of the cost and we cover the rest. The woman that takes care of my mother is payed less than $10/hr. The woman who arranged the nurse collects the rest, around $100,000 per year. The amount of work done by the woman has decreased from year to year, I have not seen her in more than a year and she faxes over the forms we need to file with the insurance company, each month.
The insurance company does not choose the nurse but I really want to keep our current caretaker. She is great with my mother and has really developed a relationship with her. What I would like to do is help her set up a company and pay her directly. We would negotiate the price down to a reasonable level thus saving us money and the insurance company money.
Any thoughts?
If you feel you can afford this on your own, then it is quite possible. But the nurse most likely will not want to form a company. She will have to look into the manner to approach this that is best for her. I worked private duty for a client who just treated us as regular employees. She had her CPA figure out the tax and social security deductions and he dealt with all that. I have no idea what paying a CPA to handle these matters would cost. I would imagine you could go through the process yourself. Or you could pay the nurse a set wage and tell her she has to do the rest. One of my employers did that. Actually that is not the right way because the employee is not an independent contractor. You have to verify this with the IRS. Whatever the arrangement, you will be best served by having the nurse draw up a contract that is mutually agreeable to both parties. Examples suitable for this situation can most likely be found on the internet. As for cost, just ask the nurse what she is being paid. Offer two or five dollars an hour more, or more if you want. You should be able to give the nurse a raise as an incentive and still be able to afford the venture. Good luck with all of this.
Another thought. I would think twice about giving up insurance reimbursement. If you are unhappy with the situation, you can communicate with the insurance company and force them to get a better situation retaining the nurse and ridding yourself of the do-nothing agency go-between. Clients change third party agencies all the time and either take the nurses with them to another agency or take the new nurses that they can get elsewhere. You have to be persistent with the insurance company though. Don't take no for an answer.
I forgot to add that after I left a case, my former supervisor told me that the insurance company took the case away from the agency lock stock and barrel and started to pay the nurses directly. They allegedly were fed up with the poor service rendered by the agencies in their inability to keep the case staffed. However, we all could see that the real reason would have to be to take the third party out of the money flow.
cali510 wrote:Another thought. I would think twice about giving up insurance reimbursement. If you are unhappy with the situation, you can communicate with the insurance company and force them to get a better situation retaining the nurse and ridding yourself of the do-nothing agency go-between.
Yes, this is my problem. I do not want to give up the insurance reimbursement. If I try to pay the nurse directly, I will be paying it in full and it will cost about the same. The insurance company will not deal directly with her and she does not have the capabilities to do it herself.
What if I set up a 3rd party to manage the nurse, paid them directly and had then submit there paperwork to the insurer. What would be the requirements for the 3rd party? Would they have to be a nurse or just someone with some business skills. This way, I could arrange to pay the nurse more and the manager could charge his fee. Everyone would win.
petersont1208 wrote:Yes, this is my problem. I do not want to give up the insurance reimbursement. If I try to pay the nurse directly, I will be paying it in full and it will cost about the same. The insurance company will not deal directly with her and she does not have the capabilities to do it herself.
What if I set up a 3rd party to manage the nurse, paid them directly and had then submit there paperwork to the insurer. What would be the requirements for the 3rd party? Would they have to be a nurse or just someone with some business skills. This way, I could arrange to pay the nurse more and the manager could charge his fee. Everyone would win.
I do not know the nuts and bolts of your question. My former supervisor was very close mouthed about the shift in who paid her and probably only mentioned it because for awhile she was afraid that her job was gone. I do know however that the insurance company did not give her a pay raise. Our agencies have a nurse who is overall supervisor of the clinical side of the business and business/general managers who handle the business end. These people may be nurses but usually have business degrees. The insurance company is just giving you a hard time. It obviously can be done where they deal directly with the employee since that is what happened to my supervisor's case. They just don't want to do it. If your nurse got the documentation to be an independent provider for medicare/medicaid, she could attempt to deal with the insurance company but I don't know that it would fly. It sounds like she is not able to do this on her own. You need to convince her to be willing to go to the agency that you select when you move your case. Unfortunately, in this scenario, the agency will still be her employer, but perhaps you will have a better working relationship.
If you are concerned about the compensation for the nurse, as you can guess, pay is a large factor in employee satisfaction when they choose home health agencies as their employers. I have no idea where you are located, but for an example, in my neck of the woods (west coast), typical pay for a noncertified home worker (works for the state) is a little over $10/hr. Agency home health aides/certified nursing assistants range from $10-$12/hr., LPN/LVNs from $16-$19/hr, RNs from $22-$25/hr for routine medical home health care. The agency is reimbursed roughly twice the amount of the employee's pay. Some agencies figure out a way to adequately pay their nurses, others whine to their nurses about their inability to pay them well. When you interview the agencies you have a right to ask what their pay scale is so that you can talk to your nurse about it. After all, you are bringing the agency a fully staffed case. In the daily scheme of things, nurses are not supposed to discuss their pay with the client, however, you are contemplating a move which may or may not be influenced by this info, so it is expected that you will discuss pay with the nurse involved. Paying the nurse, of course, is not the only consideration, but you might want to consider it in your decisions.
I would report this over charging to medicare /medical fraud. if they get paid $100000 a yr for a cna they privide for $10 an hr, if she works 40 hrs a wk, that is only $21000 a yr.
an $ 80000 profit. There is something fishy. try and get a copy of the lady's pay stub for proof first, submit to fraud unit
with her agency info and your mother's medical/medi care number.
