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Information in this guide is designed to assist the medical practitioner in determining whether a patient is appropriate for home care and whether services will or will not be covered by insurance. This is not a definitive guide and exceptions are always possible. Also, Medicare, which is usually the guiding force behind other insurance coverage, is constantly changing. Therefore, the information may have become outdated. When in doubt, it is best to contact the Sparrow Home Care Network for clarification.
Services
Sparrow Home Care Network provides a comprehensive set of home-based services including:
Guidelines
In general, if services are considered reasonable, medically necessary, can be provided safely in the home environment, and are related to the patient's diagnosis, the patient should be considered a candidate for home care. Sparrow Home Care also requires that a willing and able caregiver be available to the patient. This being the case, several requirements must be met for services to be covered by Medicare and most other insurance policies.
- The patient must be under the care of a physician.
- The physician must provide written orders for services.
- Care must require the skills of a Registered Nurse, Physical Therapist, or Speech Therapist. The patient may qualify for reimbursement of other services but only if one or more of these disciplines is required.
- Services must be part-time and intermittent.
- The patient must be homebound. Leaving the home must require a "considerable and taxing effort" on the part of the patient. They do not necessarily need to be confined to a bed. The reason for the homebound status must be related to the patient's medical diagnosis or illness. If a patient's ability to drive is restricted, but leaving the home is in no other way impaired, they are not considered homebound. The patient may leave the home for medical treatment not available in the home, if leaving requires a considerable and taxing effort. The patient may also leave the home for social activities (i.e. trip to the beauty salon, social visit, religious services, etc.) if the absences from the home are "infrequent" and for a "short duration".
If you have specific questions about whether a patient qualifies, or would like to determine if a specific treatment will be allowed under Medicare, please contact our office; we will be glad to help.
Private Insurance
Most private insurance policies now allow for home care services. Often, the criteria are very similar to Medicare. Also, there may be a deductible for services. If your patient has a private insurance policy, we will be glad to determine the extent of the coverage.
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