Se­niors of­ten must fight for Medi­care home health ben­e­fits

Walker County Messenger - - Front Page - Dana Perry Es­tate plan­ning

Medi­care is man­dated to cover your home health ben­e­fits with no limit on the time you are cov­ered. Un­for­tu­nately, few Medi­care ben­e­fi­cia­ries get the level of ser­vice they are en­ti­tled to and many find their ser­vices cut off pre­ma­turely. Get­ting these ben­e­fits can be crit­i­cally im­por­tant. Medi­care home health care ben­e­fits can mean the dif­fer­ence be­tween be­ing able to stay at home with a dif­fi­cult med­i­cal prob­lem or end­ing up in the hospi­tal or a nurs­ing home. As a Medi­care re­cip­i­ent, you are en­ti­tled to full home health ben­e­fits if you meet the fol­low­ing re­quire­ments: You must be con­fined to your home, mean­ing that leav­ing it to re­ceive ser­vices would be a “con­sid­er­able and tax­ing ef­fort.” Your doc­tor must have or­dered home health ser­vices for you. At least some el­e­ment of the ser­vices must be skilled, skilled nurs­ing care, phys­i­cal ther­apy, or speech ther­apy. You must re­ceive the ser­vices from a cer­ti­fied home health agency. Re­quir­ing an el­e­ment of skilled care also will en­ti­tle you to Medi­care cov­er­age of so­cial ser­vices, home health aide ser­vices, and the nec­es­sary med­i­cal sup­plies and equip­ment. You won’t have to pay any­thing for the home health ben­e­fits, but you will have to pay 20 per­cent of the sup­plies and equip­ment.

Un­der the law, you are en­ti­tled to 35 hours of ser­vice a week, but few Medi­care ben­e­fi­cia­ries who meet the home health care cri­te­ria ac­tu­ally get this level of ser­vice. If your ser­vices are ter­mi­nated pre­ma­turely, you will need to ap­peal. If you have to ap­peal, the good news is that most peo­ple win their cases. In fact, 81 per­cent are suc­cess­ful on ap­peal to an ad­min­is­tra­tive law judge.

If you can you should con­tinue to pay pri­vately for the care dur­ing the process. Re­mem­ber, the is­sue you are ap­peal­ing is not the ter­mi­na­tion of ser­vice, but the de­nial of Medi­care pay­ment for the ser­vice.

In order to mount a suc­cess­ful cam­paign to get your ser­vices back, you should:

Ask your home health agency to ex­plain the cut­back and write the in­for­ma­tion down.

Ask your physi­cian to call the agency urg­ing them not to cut back the ser­vices and, then have the physi­cian send a let­ter de­tail­ing the level of care you need.

Con­sult with a Medi­care as­sis­tance agency or your at­tor­ney to de­ter­mine the like­li­hood of a suc­cess­ful ap­peal.

If you de­cide to ap­peal, do so im­me­di­ately and make sure you make ar­range­ments to pay pri­vately pend­ing the re­sult of the ap­peal.

If you need help se­cur­ing home health care, con­tact your at­tor­ney.

This in­for­ma­tion pro­vided by Dana Perry, manag­ing part­ner, and other mem­bers of the Es­tate Plan­ning Prac­tice Group of Chat­tanooga-based law of­fices of Cham­b­liss, Bah­ner & Stophel, P

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