Medicare and Homebound Definition ???
 

Hi - for any of you on Medicare or who may know - would appreciate any feedback - I can no longer get IVIG at home and its been cut off by my home infusion agency cause they say Medicare will only pay for the home nursing if homebound - I see my neuro in about a week and half - but he's gone from having to stop giving infusions in his office - to having his Medicare patients now kicked off home infusion care... and any info I can go in with may help...

I talked to Medicare and their defination of homebound is really rather vague (I got someone reading from a book - nice person but really no help).....

Do you have to be bedbound? to be homebound? The only time I get out is when I pay an agency to drive me to the doctor - medical transporation for disabled here is available and I used to use them - but they have left me stranded (you cannot change a pickup time unless they have someone available, and its usually not an option)... (this is my only way to get to the hopsital if they are still doing infusions there - but its impossible to set pickup time - one can wait between one to four hours for the medicine to be brought up from the pharmacy and then the infusion is another four and a half hours - and when its done they want you OUT - so setting a time for ride home is really impossible) (which is also why I cant schedule with the agency I pay for transporatation now because the time has to be set two days in advance)

So, again, anyone in this situation or know anyone that has qualifed for "homebound" under Medicare? And if so, what are the specs???:confused:

Thanks

kmeb

I don't know?
 

Guess I'm gonna have to look it up...
Have you done a board search on the issue? I ask as many ALS, MS, Parkinsons and other boards are active more than we are and they all mite know? Worth a try - j

I would ask you infusion agency why they changed your status from homebound. Usually there is a little room to fudge. Sounds like maybe a grinchy person got hold of your file and decided to be overly strict. I would ask them for a detailed explanation, and a reconsideration.

Karen:

Can you still get it if you have it administered at the home infusion agency? I used to get mine in this manner, plus it was far less expensive this way, not that this matters to Medicare... As I recall, it seemed like a much more flexible way to get it. The IV's were mixed on site and you didn't have to wait. Easy in, easy out... Here they have a big room with TV, books, magazines, pretty laid back...

Cathie

Home Infusion
 

I mentioned in prior thread - but Medicare isnt actually supposed to pay for home nursing care (thus the infusion nurse) for the diagnosis of CIDP - only PID (Primary Immune Dificiency)... the agency I had been with had been taking Medicare patients only because they had their own pharmacy and were contracted with my Medicare Part D (which covers meds) - and thats how they were making their money... I didnt find this out until they cancelled their contract with my insurance and told me I could change Plan D's, but still no guarantee of getting home infusions any more - and no one else will pick up Medicare patients that I can find because its a loss to them.... I finally have found a pharmacy that will give me the IVIG if I am classfied as "homebound" which is necessary for Medicare to pay for the home nursing...

I dont know of any infusion sites around here (the infusion agency I had is in 48 states and sends out nurses to homes only) - (I had my first five rounds done in the hospital as an outpatient and the rest have been at home) - but will ask the doc about infusion centers - cause if they run on time could get ride set up.... (if there are some this may be the only option - because govt regs keep changing regarding reimbursement rates for IVIG for CIDP and many more hospitals are expected to stop administering to outpatients)

:(

When
 

I had to have antiboties giving moring and night last May,the hospital
have a skilled nursing home.. Medicare or 20 percent can't remember
will not let anyone have them at home unless you paid. Now they even shut
that down. Bob would take me home morning and night but medicare pays
for that room. Like you the Oats bus here takes setting up rides a week
ahead,we have people who offer rides,but day ahead. Bob will be having
sug. on leg,first time i had to tell a love one i can't take care of him at
home,breaking my heart. So he will have to pay ahead. Get together
now with social worker at hospital. That way you will be able to pick
place. Stay in hospital if you don't like nursng home. But you just check
with the hospital ss they will help so has the chaplin...Pm me,things are
a changing.. Sue

I don't know if the infusion centers where you are offer this type of thing, but I was able to locate at least 2 in our area who do them at their centers, by simply calling around and asking if they could do them there. They all had nurses they could send out and do home infusions, but in my case, the cost was important and I found out that it was about 1/3 the cost of having it done at the hospital if I actually went to the center to have it done.

I thought I was doing my insurance company a big favor by finding it so much cheaper, but they didn't act like they were very impressed... I liked it better anyway-much more laid back and the people were easy to work with...

Cathie

Karen
 

This looks as if it defines it pretty well. http://doctorsforadults.com/journals/news/jun01/q&a.htm

All you need is a statement from your doctor stating that you qualify as a homebound patient. Explain briefly why you are homebound in the letter. Be sure to get a copy. If you draft the letter for him, perhaps he will be better able to get it done in a reasonable time. Most doctor's nurses do this for the doctor they work for and if you are at all friendly to her, you might do this for her. I know my doctor's nurse is so rushed that she would be glad to have me hand her a drafted letter for signature.

Billye

Thanks all
 

Think I will talk to the doc first about "homebound" - Billye - great article and info - and based on the general description I'd certainly qualify..

Will also try to find infusion agency locations as backup - but from what I've found around here so far - they are located in the hospitals in their chemo/remicade/ivig sections.... so "day patient".....

Sue, will talk to social worker if doc has no solutions - because after an infusion I get very weak and woozy from the med for quite a while - and honestly cant imagine trying to take any kind of transportation without help!:cool: