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PAYMENT INFORMATION
Most insurance covers home care services. Listed below are a few of the most common types of coverage and some basic information about them. Our agency bills insurance companies for the patient. The billing staff can also assist you with any questions regarding service coverage. Our agency has met strict state and federal guidelines to be able to offer services to Medicare and Medi-Cal patients.Medicare
Medicare reimburses the agency and accepts this as payment in full for services, provided the agency meets Medicare criteria for coverage. Criteria for coverage include that the patient is homebound. This means that leaving home is a taxing effort for the patient and absences are infrequent, or for short periods of time only. A physician, dentist or podiatrist provides orders for skilled services. Skilled services are those of a registered nurse, physical therapist, occupational therapist and/or speech therapist. If the patient receives one of these services, they may be eligible for an aide and/or a social worker.
Medi-Cal
The agency is reimbursed at a rate set by the state. The agency may also require a co-payment if one has been established as part of the patient's coverage. Each Medi-Cal patient has a card with numbers and letters. The letters determine the type of coverage. Sometimes there is only coverage available for hospitalization and not home care. Coverage is given on a monthly basis and can change depending on the patient's economic status. Criteria for coverage are the same as Medicare.
Private Insurance and Private Pay
Not all private insurance companies use the same criteria as Medicare. We call each company for clarification of coverage and prior approval for visits. Some policies require a deductible be met or a co-payment for services. Each insurance company is different, so staff provide the patient with financial obligation information on the initial visit. Patients are also given an estimate of the frequency of visits and services that may be needed. This will only be an estimate; each individual's needs can change while on service. Our billing staff also assists with any questions you may have. Sometimes a patient requires or requests home care services and does not have insurance coverage; these patients are billed directly for services rendered. These patients are also provided with an estimate of the cost and services to be provided.
Patients Who Cannot Pay for Services
Our agency has provided charity home care services at times. If a patient has no coverage and no ability to pay for home care services, the case is discussed with the management staff. The agency makes every attempt to identify resources available to help meet these patient's healthcare needs.
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