Out of Pocket/Private Pay Services
Our services are available to anyone wishing to hire us on an out of pocket/private pay basis. A current fee schedule is available upon request. Invoices are sent out monthly to the established responsible payer and payment is due within 15 days of receipt.
Does Medicare/Insurance Pay for Home Care Services?
"Home Care" is an umbrella term that describes all forms of home care available. Insurance companies use this term broadly to describe services and it can be very misleading when trying to determine what your insurance will pay for at home. Many people have spoken to their insurance and are told that " we will cover up to 35 hours a week of Home Care". Here is what that really means:
Medicare, like all other medical insurances (Anthem, Blue Cross, Etna, Etc.) only pay for medical home care. Examples of this would be home care ordered by a physician for an acute/short term medical treatment need. This would include registered nurses for care such as wound changes, IV treatments, as well as Physical, Occupational and Speech therapy. This medial care is always short term, usually right after a hospital stay. While receiving the care of RNs and therapists at home, a bath aide may also be sent out a few times a week. Each of these specialties will come out for about an hour at a time for each of their visits. While receiving this kind of care, most people will never reach "up to 35 hours a week". That happens when a client needs daily wound care by an RN or IV changes multiple times a day by an RN in addition to the therapy they are getting and possibly a bath aide. That is were "up to 35 hours" comes in, when the total of all in home medical care reaches 35 hours a week. It usually does not.
Activity of Daily Living (ADL) assistance like bathing, dressing, incontinence care, transfer/mobility assistance, supervision, housekeeping, meal preparation and other daily tasks are part of Home Care services but are not considered to be medical care and so cannot be billed to any medical insurance. This kind of care is NOT included in the "up to 35 hours a week" that insurances state they provide. Although a medical concern may have been what prompted a client to need this kind of help at home, it is not considered medical care. Our caregiver services are considered non-medical and thereby not billable to any medical insurance.
Help paying for Home Care Services
While medical insurances do not cover the cost of ADL assistance at home, there are some resources available and we encourage you to pursue them. We are an approved provider for nearly all local funding programs and can help you navigate what may be available to help you cover the cost of non-medical Home Care. The following links will take you to the webpages for all local assistance programs available, all of which we are a provider to:
*PA Community Health Choices (PA WAVIER Program)
Long Term Care Insurance
Long Term Care Insurance: Some clients have purchased separate long term care insurance policies specifically to cover long term home care or nursing home care. This would be a policy separate from your medical insurance cover and purchased from a carrier such as Bankers Life, Metlife, etc. Every policy is different as far as what is covered and their requirements. This is all based on what the individual purchased. We can potentially provide non-medical services under these programs dependent on their specific requirements.