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One of the most frustrating events for people facing rehabilitation is thinking that their insurance is going to pay for everything and finding out that their insurance will not pay for the complete services required for a successful rehabilitation.
Nursing home skilled units want to be reassured that the essential steps will be taken to assure that they will be paid. Nursing homes are most familiar with Original Medicare, Medicare Advantage Plans, Medicare Managed Care Plans, Medicare Preferred Provider Organization Plans, Medicare Private Fee-for-Service Plans, Medicare Specialty Plans, federal employee health program, military health program and railroad retirement programs. If your patient has one of these, they?ll be extremely regarded as once that payer source is confirmed.
Medicare Part A is the primary source of insurance that will pay for a skilled nursing home stay. Medicare pays 100% of day 1 through day 20 and from day 21 up to day 100 Medicare will pay everything less $114.00 per day co-pay as long as the resident is generating progress on the way to their rehabilitation objectives.
If, Medicare is managed through a HMO (Health Management Organization) it usually pays 100% of the rehabilitation stay. The HMO determines the duration of stay by the assessments offered to them by the nursing home rehabilitation employees and also the degree of independence required where the resident will live after their rehabilitation stay. The HMO relies on a Nurse Case Manager and a Medical Director who?s a physician to make this determination.
Secondary insurances with Medicare Supplemental Coverage will generally pay the $114.00 per day co-pay from day 21 through day 30 up to day 100 based upon the tier degree of the insurance plan and some sections will some times pay up to 120 days. It is important for you to know what your insurance will cover.
If you have the resources you can of course pay the Medicare $114.00 per day co-pay privately.
Most states provide a Medicaid Program for individuals who meet the financial eligibility and medical need criteria. Please contact your State?s Department of Human Services Income Support Division (local Medicaid office) to see in the event you or your cherished one fulfills the criteria for assistance. Most individuals fear that they might loose their home or all of their earnings and property if they apply for assistance. You will find laws and regulations in each state that provides Medicaid to protect the home or homestead and to protect the spouse from poverty. There are also attorney?s that specialize in Elder Law that may help you protect your income and property and plan for the transition to State Medicaid Assistance when you or your loved ones resources become exhausted.
Nursing homes generate income from providing rehabilitation services to keep financially afloat. They check to see that they?ll make money from providing the patient the services they need. That means that everything the patient needs in the way of remedies, therapy and medications must be covered by your insurance before they agree to accept a patient from a hospital.
The nursing home will also want to get an understanding of the patient?s cognitive status and psycho/social-well-being to see that they are appropriate for their facility unless they?ve a contract with the discharging hospital. Keep in mind that not all nursing houses are adapted to serve all types of patients. If you or loved one has some behavioral problems, related to dementia, Alzheimer?s disease or psychiatric problems they may not be accepted for admission. You may need to find a nursing home that specializes for those kinds of paient needs.
Understanding your insurance advantages and your needs will get you the services you require for a successful rehabilitation stay.
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