Medicare Coverage of In Home Help

[Mareva]

Has anyone had success in having their neurologist write a care plan following the Medicare guidelines so that the MS patient has Medicare pay for 'in home care' ?

My friend is being drained because there is no written plan with the proper verbiage to trigger Medicare coverage.

Does anyone have a care plan that has triggered Medicare coverage?

Friend of a MS friend

[Sarahsmom46]

I have dealt with this issue recently and wanted to give my feedback.

The only things covered under my health care plan, which is one of the best plans for government employees, will only pay for PT, OT and maybe speech therapy and only home health for personal care or homemaking chores IF I were bedridden.  

I was given some great advice prior to being discharged from the hospital back in May to get in touch with the county disability or elderly  services and request an evaluation by a social worker.  That is exactly what I did and through this social worker was made aware of the services available, like housekeeping and personal care which the insurance company was not covering.  They never asked for a doctor's chart notes or formal request or anything.  

Have you guys looked into this as a possible option?

Oh, it just occurred to me, she can also see another type of doctor - a physiatrist or rehabilitation doctor.  This is better than a PCP and even a neuro in my opinion.  

I hope you guys can find a solution because like you said this is very draining on those of us who are facing these issues.  

Let us know how this turns out.

Julie

[Lulu54]

Hi Mareva and welcome.  this is a great place to ask questions and I hope we can be of help to you and your friend.

I'm not sure if the primary care doc has enough knowledge abuot the needs of an MS patient to write a comprehensive care plan.  Does this person have a neurologist to provide care?  I would go there as well and discuss the needs in an honest conversation.

We are pretty pathetic here in the US about providing necessary care in these cases - I'm so sorry your friend (and you) are struggling with this. Good luck with finding answers.

my best, Lulu

[Spaceystac]

Sorry to hear your friend is having trouble with the system, let her know she is not alone in this battle.
   It says on medicare.gov that you need a doctor the is currently treating you to write the care plan. This means it is possible to see if your friends primary care wouldn't mind doing it.

   What is the doctors plan? Physical Therapy? Occupational Therapy? Those are the things that should be recommended to be done at home. I would suggest that if her Neuro wont do it, she should get copies of her records and write the plan up for the doctor. All he will have to do is submit it.    She would need copies all her referrals pertaining to her in home care.  Sometimes, people can be reimbursed for out of pocket costs that are later proved to not be owed for certain circumstances.

Below is info on the topic, good luck to you and your friend!

http://www.medicare.gov/publications/pubs/pdf/10969.pdf