Wednesday, January 29, 2014

Health Insurance Prepaid Care and past delivery perceptions

There was once the idea that if you had health insurance you would be given everything the medical staff felt you needed.  This was a model of prepaid care.  With the health delivery systems need to change from treating acute incidence of illness to caring for more chronic complex disease processes this looks a little different. 

More and more medical procedures are being scheduled and conducted in an outpatient setting.  Services that once were done in a hospital resulting in a stay, can now be done in a clinic room and the person is sent home.  With the expansion of outpatient specialty service staff are challenged to document a plan of adequate support post procedure to reduce the risk of a hospital admission.

This transition can be a bit different for the medical provider and the family.  Often after a procedure the person will need additional help with medications, meals, dressing, toileting, walking, transferring, and organizing follow up appointments.  The outpatient delivery staff are required to document how these daily needs will be met, but there is no designated pay source for this type of service.  Health insurance pays a percentage of the bill while you are in the outpatient setting receiving the service, but once you leave the insurance payment stops.

The health insurance (payer) plan is defining the skilled outpatient procedure as a separate part of the patients treatment and recovery experience.  The Public and Private (payer) health insurance provider is designating the skilled outpatient services as different from the post procedure care a supportive home care organization can deliver at a lower cost. 

Medical providers express feeling awkward referring a family to a service that is not covered by insurance.  Families express difficulty finding the information that would facilitate an informed decision when hiring a supportive home care organization to deliver the temporary post outpatient procedural care needed at home.

A big part of this shift to increased scheduled outpatient procedures is connecting the family to a supportive care agency that can help at home for a short time. 

  Home Care Path celebrates 4 years of successfully serving seniors in South Central Wisconsin

 
 

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 Home Care Path  www.homecarepath.com and the Wisconsin PATH ALONG model deliver an advanced supportive care service.  Helping seniors in the home, with clinic visits, at the hospital, nursing home and assisted living facility.  Helping seniors downsize with a move in to an adult child's home. 2014 rates are 20.00 per hour.  Simply call 608-432-4286 to schedule an interview.  We can be there when you are working.  We accept long term care insurance.  Services can be tax deductible.  Help with resources and the transition from private payment to public funded programming.  Valuing home and human life

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