On Feb. 29, Maleck Manteghi received a form letter from the Hills Physicians Medical Group of San Ramon saying that his wife, Guity, no longer needed skilled nursing care and it would halt payments to her nursing home the next day. Eight weeks earlier, Guity’s heart had failed, cutting off oxygen to her brain and sending her into a coma. Shocked, Manteghi appealed the decision to Blue Cross. Manteghi’s situation is not uncommon. Many insurance plans don’t pay for skilled nursing care in a medical facility if the plan determines the patient’s care could be provided by nonregistered nursing staff or family members. Families in similar situations have only a few options: They can appeal the health plan’s decision, take the case to arbitration or, in some cases, sue. If all those options fail, families are on their own to cover the costs unless they can qualify for federal or state aid.– The Law Offices of Bruce G. Fagel & Associates