Home Health Medicare Opt Out

[rousemark]

Not at all. Although what Somarco posted applies to everybody, you hardly ever see it with doctors, hospitals and even hospice. They love that dollar too much.

But you do see it a lot with HH. Probably got a lot to do with what they can charge. And some charge a lot. Especially the chains and franchises. They charge double what the smaller independents do.

They get away with it because they know that a family ... yes family entering a time like this is vulnerable and most don't know where to start. But you and I already know this part.

Mine is averaging $250 per visit. Haven't paid any attention to Medicare approved amount.

 

[somarco]

Medicare opt-out database . . .

[EXTERNAL LINK] - Centers for Medicare & Medicaid Services Data

and . . .

[EXTERNAL LINK] - Centers for Medicare & Medicaid Services Data

 

[Todd King]

They were supposed to present a document to her telling her that they don't do assignment and she has to sign it. If they can't produce that piece of paper, then she's in the right and they'll have to take what Medicare gives them.

 

[somarco]

They were supposed to present a document to her telling her that they don't do assignment and she has to sign it. If they can't produce that piece of paper, then she's in the right and they'll have to take what Medicare gives them.

The HH company opted out of Medicare . . . not the same as not taking assignment.

 

[rousemark]

They were supposed to present a document to her telling her that they don't do assignment and she has to sign it. If they can't produce that piece of paper, then she's in the right and they'll have to take what Medicare gives them.

Sounds as if you are making the same mistake I made... confusing non-participating with opt out.

 

[Todd King]

"The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you."

Did she sign a contract with them then?

 

[kgmom219]

This is 100% total, unadulterated BS.

1. The senior, in the middle of a health crisis, is told to use this Home Health Agency from the hospital.
2. The Home Health Agency may or may not had her sign a form showing they weren't covered under Medicare. Which is exactly what our seniors need in the middle of a health crisis.
3. When she asked, they lied to her. (That's a complaint to the state HHS, BTW)

TX and CA answer on Home Health: I don't know of any that do not accept assignment.

Don't throw anything at me answer: This is when MAPD works better than OM. Assuming they actually approve the Home Health.

Let me know if you need to call and yell at someone. This is unconscionable from top to bottom. The hospital who arranged the Home Health. (Kickbacks, perhaps?) The social worker at the hospital should have her license pulled. The Home Health Agency needs to be investigated.

Want to fire me up? Take advantage of seniors when they are sick.

 

[kgmom219]

Just so this doesn't get lost. There are 3 types of providers for Medicare billing:

1. Accept Assignment. They take it and accept the Medicare allowed amounts
2. Opt-Out. They do not take it and will not bill it. Its cash pay, ONLY. There are no claims to file at Medicare
3. Excess Charge Providers. They do not accept assignment AND have not legally opted-out. Usually they file claims and wait on payment from the carriers if the insured has Plan F or G. If its N, its not covered. Sometimes, they want their "excess" money upfront. In reality, they can do whatever they want. Had 2 claims in TX in 20+ years. But in Arizona, Mayo Hospitals do not accept assignment and you better have G or its going to be ugly.

 

[somarco]

"The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you."

Did she sign a contract with them then?

Can't say. Been trying to get with her for a few days now. She is neither a prospect, nor a client, merely a referral from an existing client who I agreed to speak with.

 

[rmhaire]

Can't say. Been trying to get with her for a few days now. She is neither a prospect, nor a client, merely a referral from an existing client who I agreed to speak with.

Just curious. Do you have a bullseye painted on your back by any chance? They seem to be looking for you.