Insurance & Payment Information
Anyone is eligible for home care.
Medicare, Commercial Insurance and Private Pay are all possible payment sources for home health care services. However, third party payers have specific criteria that must be met to cover services.
Medicare Benefit Guidelines
Medicare covers 100% of home health charges if the patient meets the following conditions:
- The Patient is Eligible for Medicare Coverage.
- The Home Health Services are Ordered by the Patient's Physician.
- The Patient is Essentially Homebound.
- The Patient Requires Skilled Care.
- The Patient Requires Intermittent Care.
A patient is considered homebound if he or she experiences a normal inability to leave home. The patient's physical condition and/or physical limitations are such that it would be a considerable and taxing effort for the patient to leave home.
For home services to be covered by Medicare under either Part A or Part B the patient must need at least one of the following services
- Skilled Nursing
- Physical Therapy
- Speech Therapy
If one of the above services is providing care, then the patient may also receive Occupational Therapy, Medical Social Services, and Home Health Aide care as needed. Necessary medical supplies and durable medical equipment may also be covered.
A patient must have a medically predictable recurring need for skilled services. Generally this means at least one visit every sixty days. Medicare does not cover hourly or shift care, housekeeping, or homemaker/companion services.
Commercial health insurance policies typically cover home care; however, benefits vary from plan to plan. Coverage is verified prior to the beginning of care. Scottsdale Healthcare Home Health makes a sincere effort to inform patients of anticipated financial responsibility for home services, but patients are ultimately responsible for the benefits and limitations of their insurance policy(s), including deductibles, co pays, and non-covered services. The patient and/or family has the right to be informed of their financial responsibilities, Medicare and/or insurance coverage prior to admission for services and prior to change in rates, charges, or services, orally and in writing as soon as possible, but no later than 30 calendar days from the date the Home Health Agency becomes aware of the change. This may also include the use of the Home Health Advance Beneficiary Notice.
Long Term Care Insurance
Long Term Care Insurance generally pays for home health care. Depending on your policy and provider you may be assigned a case manager to oversee your care. You will need a doctor's note specifying that you need help with several activities of daily living (ADL) to begin a claim. You will have a choice of home healthcare agencies at the time your claim is approved.
Home care services that fail to meet the criteria of third party payers must be paid for "out of pocket" by the patient or other party.
Every patient’s situation is unique, contact us at 480-882-4222 to discuss your specific eligibility criteria.
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