Home Health Insurance and Financial Coverage
It is the policy of Doylestown Hospital Home Health to discuss insurance coverage and financial obligations with each patient prior to the initiation of home care services and at the time that the level of insurance coverage changes. It is not possible to predict the exact cost of services and the amount of coverage from insurance programs; however, it is our intention to provide the patient and family with as clear an idea as possible. A copy of the insurance information obtained by our department from the patient's insurance carrier will be given to the patient at the time of admission.
Most of these services are covered by private insurance plans, major medical insurance, HMOs, Medicare and Medical Assistance. We provide these services without regard to race, color, religion, age, sex, national origin, physical or mental handicap, sexual orientation, or even ability to pay. We review insurance coverage and make every attempt to provide patients with information regarding copays and deductibles.
Most of the services provided by Doylestown Hospital Home Health are covered by most of the major insurance carriers. All patients are encouraged to contact the Visiting Nurse Business Office at 215-345-2202 with any questions regarding insurance coverage or the charges for our services.
You may wish to discuss payment terms or alternate funding arrangements with the Doylestown Hospital Home Health office, at 215-345-2202. A social worker is available to assist in this process.
Blue Cross, Commercial Policies and Managed Care
Blue Cross has a variety of plans that vary in their level of coverage for home care and other services. Commercial policies and HMOs are all quite distinct in their policies. Issues of insurance coverage, deductibility, and co-payment will be discussed with the patient and family members by the referral nurse prior to beginning home care services.
Medicare + Choice Plans (Managed Care Medicare)
Medicare offers managed care plans through various insurers. Blue Cross Personal Choice 65 and Blue Cross Keystone 65 are examples of Medicare + Choice plans. Many of these plans have co-payments for home health services. Also, Medicare requires us to provide each beneficiary with information prior to discharge about how to appeal a coverage decision. The form you will sign prior to discharge is included in this folder for your review.
Change of Insurance Coverage
It is your responsibility to notify the Visiting Nurse Department if there is any change in your insurance coverage. Should you not notify us of changes, or if the information you provide is incorrect, you will be billed directly for the services provided.
About Medicare Coverage
Medicare pays for "skilled" services that are "medically necessary." These services are the ones that can only be (by law) provided by a licensed healthcare provider; that is, a registered nurse, licensed physical therapist or speech therapist. When care is provided by one of these licensed practitioners, the services are usually covered by Medicare. The patient can then also have help from an occupational therapist, home health aide or medical social worker.
As the patient improves or stabilizes, it is not uncommon for the "skilled" portion of the care to no longer be required. For example, an unlicensed practitioner (such as a home health aide) may be fully capable of providing all of the needed services. In most instances, these "less-than-skilled" services are not covered by Medicare but can be paid for directly by you. Your nurse or therapist will inform you when it appears that skilled services are no longer required so that appropriate plans can be made.
A patient must also be "homebound" in order for Medicare to pay for services. To be considered homebound, there must be a normal inability to leave the home. Absence from the home must be infrequent and of short duration to receive medical care. A patient is NOT homebound if he or she leaves home frequently for business, work, or school.
Face-to-Face Encounter Required by Medicare
A recent change in the law adds a new requirement to qualify for Medicare coverage. The new law requires that the patient be seen face-to-face by the physician, or certain non-physician practitioners working with the physician, before home health services start or soon thereafter.
The key elements of this new law are twofold:
- The patient must have the face-to-face visit within 90 days prior to starting home care or within 30 days after the start of care. Also, the visit must be for medical service related to the reason why home health services are needed.
- The physician responsible for performing the initial certification (admission or start of care) must include the date of the encounter.
It is your responsibility to be seen by a physician within this designated timeframe.