Resident, Sponsor and/or Resident Representative. The Resident, Sponsor, and Resident Representative understand that the Facility is available to assist with securing third party coverage (including but not limited to Medicaid), but it is ultimately the responsibility of the Resident, Sponsor and Resident Representative and the Resident, Sponsor and Resident Representative shall take all necessary steps to apply for, and qualify for, such coverage in a timely manner. Care provided to a Resident who does not meet the eligibility criteria for coverage by third party payors will be billed at the Facility’s private pay room and board rate. The Resident, Sponsor and Resident Representative agree to provide the Facility in a timely manner with all relevant information and documentation regarding all potential third party payors including, but not limited to, what benefits, if any, may be available from the Resident’s insurance and/or managed care plan and to notify the Facility immediately of any change in Resident’s insurance status or coverage. Depending on the insurance coverage, managed care plan and/or written agreement with the Facility, additional charges, including co-insurance, deductibles and/or co-payments, may be imposed. Furthermore, prior authorization by the insurance carrier or managed care plan does not guarantee coverage and/or reimbursement. In the event of denial of payment by a third party payor, exhaustion of benefits and/or termination of coverage, the Resident and/or Sponsor shall be responsible for payment to the Facility. The Resident must promptly notify the Facility of any notice of a third party payor’s discontinuation of payment (coverage).
