Changes in modern medicine affect the way health care coverage is deployed by insurance companies. Providing patients' in home care was once unheard of, but now it often proves more cost effective and convenient than a lengthy hospital stay. Knowing what your health insurance benefits cover will better prepare you to advocate for your insurance company to supply a home care provider for you or a loved one.
Instructions
1. Assess whether the patient meets the minimum requirements to receive in home care. To qualify for a home care provider under Medicare the patient must require at least one of the following services, according to your doctor: Intermittent skilled nursing care, speech-language pathology services, physical therapy or continued occupational therapy. Patients' requesting home care must also be either homebound or barely able to leave home unassisted. Most insurance providers will require that at a minimum the patient meets these conditions.
2. Determine the level of care the patient requires. For your insurance company to provide the patient in home care the patient must need less than full time care. This means a home care worker would spend fewer than seven days a week with the patient and attend to the patient's needs for less than eight hours per day. If a patient requires more intensive treatment or medical supervision it is unlikely that the insurance company will pay for a home care provider.
3. Develop a relationship with the treating physician and ask the doctor to write a letter on the patient's behalf to the insurance agency requesting a home care provider and delineating the medical necessity of the claim. Submit your request for an in home care provider to the patient's insurance company along with the doctor's letter.
4. Prepare to fight the insurance company for an in home care provider. Most non-HMO insurance claims are denied the first time they are submitted. If the patient's claim is denied request a second letter from the treating physician and re-submit the claim. You may have to do this more than once, but being persistent pays off.
Tags: home care, insurance company, care provider, home care, home care provider, home care provider
