U.S. CitiesCity-Data Forum Index
Covid-19 Information Page
Go Back   City-Data Forum > General Forums > Health and Wellness > Health Insurance
 [Register]
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
View detailed profile (Advanced) or search
site with Google Custom Search

Search Forums  (Advanced)
 
Old 05-02-2017, 09:30 PM
 
1,616 posts, read 3,849,736 times
Reputation: 1858

Advertisements

HI,

Hope this is the right place to ask...

A relative is currently in the hospital -- in the ICU actually. She does live in assisted living and has a
very bad pressure ulcer on her heel that will get debridement surgery tomorrow. A hospitalist has already said she will need long-term IV antibiotic treatment when she leaves the hospital. She has only Original Medicare, no Medigap plan. We simply could not afford it.

I have read online that Medicare will NOT pay for infusion therapy out of a hospital venue? The case manager at the hospital already asked me today "who to call about co-pays" as they look into discharging her back to the assisted living when it is time.

I am terrified we are going to blow out her one credit card with "stuff" from and after this hospital stay ... and then we are in deep trouble.

Can someone give an idea about what it might cost the patient to get 6 weeks or more of multiple IV therapies? I know I can try to get some info from that hospital case mgr but she didn't sound too knowledgeable... If it matters this is Texas...

Many thanks!!
Rate this post positively Reply With Quote Quick reply to this message

 
Old 05-02-2017, 10:50 PM
 
Location: Wisconsin
23,546 posts, read 50,140,471 times
Reputation: 18197
Medicare Part A will pay for infusion therapy under its home health benefit if the patients are serviced by a Medicare-certified home health agency, as well as considered to be homebound and in need of intermittent (not 24 hour) home nursing. Infusion therapy can also be administered in a skilled nursing facility.
Quote:
Does Medicare cover home infusion therapy? Unfortunately, Medicare’s fee-for-service program (Parts A, B and D) is the only major health plan in the country that has not recognized the clear benefits of adequately covering provision of infusion therapies in a patient’s home. Because most Medicare beneficiaries are enrolled in the fee-for-service program, when seniors and the disabled find they may need infusion therapy they often find it unaffordable to receive this care in the comfort of their home.

Providing home infusion therapy involves not only the delivery of medication, but also requires professional services, specialized equipment and supplies to ensure safe and effective administration of the therapy. While most infusion drugs may be covered by the Medicare Part D prescription drug benefit, the Centers for Medicare & Medicaid Services (CMS) has determined that it does not have the authority to cover the infusion-related services, equipment and supplies under Part D. As a result, many Medicare beneficiaries are effectively denied access to home infusion therapy and are being forced into receiving infusion therapy in hospitals and skilled nursing facilities at a significantly higher cost to Medicare and at great inconvenience to the patients. NHIA is underway with a critical legislation initiative to rectify this situation.

In Medicare Part B, there is some coverage for certain therapies administered using durable medical equipment (a mechanical or electronic external infusion pump). Unfortunately, only a select few therapies are covered and only under very specific conditions. These include some anti-infective, some chemotherapy drug, some inotropic therapies (e.g., dobutamine), some pain management, immune globulin administered subcutaneously, and a few other therapies. For parenteral and enteral nutrition therapies, there can be coverage in Part B only if the need for the therapy is documented to be for at least 90 days and other coverage criteria are met. There may be coverage for intravenous immune globulin (IVIG) for primary immune deficiency patients but the supplies and equipment are not paid for. More specific information can be obtained by contacting the Medicare entities called Durable Medical Equipment Medicare Administrative Contractors (DME MACs). The coverage criteria for home infusion that all contractors follow are found from a DME MAC.

For home nursing visits needed for beneficiaries receiving infusion therapy, there can be Medicare Part A coverage under Medicare’s home health benefit only if the patients are serviced by a Medicare-certified home health agency, as well as considered to be homebound and in need of intermittent (not 24 hour) home nursing. NHIA’s Medicare legislation initiative is intended to broaden this gap in coverage too.

Some Medicare fee-for-service plan patients may have other insurance that will pick up some of the home infusion costs not covered by Medicare. A minority of the Medicare population is enrolled in the Medicare Advantage (Part C) program. Similar to most commercial health plans, many Medicare Advantage health plans cover home infusion because they recognize it will reduce their overall health care costs and achieve high levels of patient satisfaction.

Most home infusion therapy providers are familiar with Medicare’s coverage details and will advise prospective patients of their specific coverage and anticipated out-of-pocket obligations should they undertake home infusion therapy.

https://www.nhia.org/faqs.cfm#faq12
Can't help you on the actual dollar cost, however. Your hospital contact should know.

Last edited by Ariadne22; 05-02-2017 at 11:12 PM..
Rate this post positively Reply With Quote Quick reply to this message
Reply
Please update this thread with any new information or opinions. This open thread is still read by thousands of people, so we encourage all additional points of view.

Quick Reply
Message:

Over $104,000 in prizes was already given out to active posters on our forum and additional giveaways are planned!

Go Back   City-Data Forum > General Forums > Health and Wellness > Health Insurance

All times are GMT -6.

© 2005-2021, Advameg, Inc. · Please obey Forum Rules · Terms of Use and Privacy Policy · Bug Bounty

City-Data.com - Contact Us - Archive 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 - Top