Home Health Care Stories
The Center has been hearing from people unable to access Medicare-covered home health care, or the appropriate amount of care, despite meeting Medicare coverage criteria. In particular, people living with long-term and debilitating conditions find themselves facing significant access problems. Below are some selected stories on the importance of home health care and the ability to remain at home.
Longtime Center Client Rosalie Berkowitz on the importance of being able to stay in her home (A StoryCorps portrait)
D.E., Ohio - Agency Refusing to Bill
My father has ALS, my mother is in a wheelchair following a stroke. [The Home Health Agency] refuses to bill any more than two hours a day for my mom (Anthem Medicare) and will not bill any at all for my dad even though they both are entitled to 4-5 hours a day of home health care. I filed a grievance with Medicare and they sent a letter stating that Interim has to bill Anthem for all services covered or not. So far that is not happening… My father has VA benefits and Interim states they cannot bill both VA and Medicare, even though I contacted both VA and Medicare and as long as they are not billing the same hours, it is ok. This is insane!!! Why all this anguish during end of life care?”
M.L., Illinois - Different Standards for Medicare and Private Pay
I attempted to get home health coverage … in Wheaton, Illinois… When I contacted them and they saw that I had some nursing benefits available through my private insurance they were eager to set up visits, but when I informed them that I had exhausted those benefits, and that I wanted this to go through Medicare, they said that I did not qualify. I did get some PT and OT, which was billed to my private insurance but they would not split bill Medicare for nursing and bill my private insurance that still had therapy benefits available. I was told that I… could get no more therapy because I do not have goals for improvement. I later spoke to the woman in charge of the billing… Her response was that coverage was given according to the ‘individual home health agencies’ interpretation of the Medicare guidelines…