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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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Hospice company says only Medicare and denies comforts such as PureWick and airbrushing saying that Medicare doesn’t allow without getting the items and passing the bills to Medicare so Medicare can pass them to GEHA. How can I make this work?
I don't think Medicare covers the costbof the PureWick system anymore. Just read u may get the catheters thru part B.
Medicare pays for supplies like Depends, chuxs and wipes. They pay for the drugs needed for comfort. Durable equipment, like a hospital bed, oxygen, ect. A nurse who comes in a couple of times a week and an aide 2 or 3x a week for bathing and any xtra hours u may be able to get.
You need to call the secondary insurance to see if they cover the PureWick system. I guess u can't bill to them directly because they are secondary and seems Medicare no longer covers them. By buying it and submitting paperwork to Medicare they have to refuse to pay and then send it onto the secondary to see if they will cover it.
If Mom is bedbound a catheter can be used. Not sure if I understand the need for airbrushing? Are u talking about make-up? Medicare is a health insurance. No health insurance would cover this. Hospice should give you a list of what is covered. Anything not provided that u feel Mom needs will have to come out of her pocket.
My experience with each of my in-laws was that Hospice and all related equipment and services was 100% covered by Medicare. It was the best possible experience under trying circumstances.
Donna, when my late husband was under hospice care in our home for the last 22 months of his life, he was initially under my BCBS plan along with his Medicare, and the hospice agency we used billed both BCBS and Medicare for many months until I dropped my husband off of my insurance and he was then strictly under his Medicare. Everything was still covered 100%, but I know that Medicare has strict limits in what they will pay for said services from hospice, and with having additional insurances for them to be able to charge, they(hospice)in the long run make out better as they are able to recoup more money than if strictly dealing with Medicare. It's a bit of a racket for sure, but know either way your mother will receive the same and hopefully the best care possible from hospice. Wishing you the very best as you take this final journey with your mother.
Ok so your mom is FEHIB so either she or your dad was a fed? And they have GEHA as their secondary to their Medicare, is that it? Dealing with this I have some experience with as my dad was a fed and they had BCBS (not GEHA) and I will say coverage was beyond excellent with almost next to zero copay when it was all about the usual health care coverage for physician, out patient, clinic / hospital coverage, lab and pharmacy stuff as the sheer # of fed retirees was huge for their service area for those that stayed on Original Medicare with the Blues coming in as a traditional secondary health insurance provider.
But hospice is different as it is Medicare Part A benefit only - in my understanding - and as such it has vendor agreements set up with hospice groups / agencies under Part A coverage to provide the in home services (of coming into your folks home 2-3 maybe 4 times a week). That is what I think is going to be the problem for GEHA in that they may not have vendors set up to be paid under Part A system. Does this sound like what is happening?
Fwiw hospice is self directed, so mom can switch hospice agencies.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Medicare pays for supplies like Depends, chuxs and wipes. They pay for the drugs needed for comfort. Durable equipment, like a hospital bed, oxygen, ect. A nurse who comes in a couple of times a week and an aide 2 or 3x a week for bathing and any xtra hours u may be able to get.
You need to call the secondary insurance to see if they cover the PureWick system. I guess u can't bill to them directly because they are secondary and seems Medicare no longer covers them. By buying it and submitting paperwork to Medicare they have to refuse to pay and then send it onto the secondary to see if they will cover it.
If Mom is bedbound a catheter can be used. Not sure if I understand the need for airbrushing? Are u talking about make-up? Medicare is a health insurance. No health insurance would cover this. Hospice should give you a list of what is covered. Anything not provided that u feel Mom needs will have to come out of her pocket.
Everything was still covered 100%, but I know that Medicare has strict limits in what they will pay for said services from hospice, and with having additional insurances for them to be able to charge, they(hospice)in the long run make out better as they are able to recoup more money than if strictly dealing with Medicare.
It's a bit of a racket for sure, but know either way your mother will receive the same and hopefully the best care possible from hospice.
Wishing you the very best as you take this final journey with your mother.
But hospice is different as it is Medicare Part A benefit only - in my understanding - and as such it has vendor agreements set up with hospice groups / agencies under Part A coverage to provide the in home services (of coming into your folks home 2-3 maybe 4 times a week). That is what I think is going to be the problem for GEHA in that they may not have vendors set up to be paid under Part A system. Does this sound like what is happening?
Fwiw hospice is self directed, so mom can switch hospice agencies.