June 25, 2015
When you think of home health care, older adults may come to mind first. You may not realize, though, that there is also a growing need for pediatric home health care services.
So what situations might require a family to need pediatric home health care? Several scenarios exist, but a few examples include children who are ventilator-dependent or who require multiple medications throughout the day.
Below, I answer some commonly asked questions about home health care.
- Is home care cost-effective? Yes, both in the short and long term. According to a 2013 study published in the Cleveland Clinic Journal of Medicine, home care resulted in a 50 percent reduction in the rehospitalization rate of home care recipients and a cost savings of nearly $3,000 per patient over a 24-week period.
- Do I need to have Medicaid to receive coverage? It depends on your insurer, but a lot of families are amazed to discover that many commercial insurance companies will cover private nursing. Typically, people think it’s only Medicaid, but United, Blue Cross Blue Shield and others will cover it as well.
- Can I file an appeal? Yes. If Medicaid denies a family’s claim for home health care, parents will receive a letter in the mail informing them of the decision which also explains the appeals process. Parents have the right to appeal and ask for a hearing.
- Am I covered throughout Texas? If a family in Texas has Medicaid as their primary insurer, then they’re covered anywhere in the state for private nursing care and reimbursement. For example, if a patient in Austin is traveling to Dallas and needs a nurse with them, they’re covered. This applies to commercial insurance as well. The minute you leave the state, though, you won’t be reimbursed with Medicaid. Commercial insurance policies vary, though many allow coverage out of state.
- Can a nurse accompany my child to their doctor’s appointments? Yes! In fact, when a child with special needs has detailed doctor’s instructions, it’s often preferred that a nurse go along to the appointment as well.
Deciding to receive home health care is a big decision for any family, but with these insights in mind, hopefully you’re one step closer to figuring out if it’s the best fit for your family.