Hospice Payment

Medicare Part A/Medicaid:

Medicare and Medicaid pay a fixed daily rate for hospice services. The following services may be included in this daily rate to the extent they are related to and medically necessary for your terminal illness, and Adya Hospice & Palliative Care authorizes and arranges such services:  nursing, social work, spiritual counseling, hospice aide, homemaker, volunteer, dietary counseling, activity therapy, prescription medications, medical supplies, medical equipment, short-term inpatient care for pain and symptom management or respite, and ambulance transportation. There are no deductibles, co-payments or other amounts due if you have Medicare or Medicaid hospice benefit. You will not be refused care or have your hospice care discontinued or reduced due to your inability to pay for that care.

 

Commercial Insurance:

Adya Hospice & Palliative Care contracts with most insurance companies to provide hospice care. Most insurance companies pay a fixed daily rate for hospice services. The following services may be included in this daily rate to the extent they are related to and medically necessary for your terminal illness: nursing, social work, spiritual counseling, hospice aide, homemaker, volunteer, dietary counseling, activity therapy, prescription medications, medical supplies, medical equipment, short-term inpatient care for pain and symptom management or respite, and ambulance transportation. Some insurance companies pay for medication, medical equipment and transportation services separate from the fixed daily rate. In most cases, your insurance company will pay hospice directly; however, there are frequently deductibles, co-payments or other amounts not covered by commercial insurance. You will be responsible for paying these amounts.  Adya Hospice & Palliative Care will attempt to coordinate between you and your insurance company to determine what these charges may be. You must inform Adya Hospice & Palliative Care immediately if there are any changes to your insurance policy.

 

Room and Board for Nursing Home Patients:

Room and board payments are dependent on the level of hospice care the patient needs at the time. The level of care is determined by the physician and Adya care team and is based on the patient's clinical needs. A Billing Form will be completed and signed by the patient or patient representative if the patient resides or plans to reside in a nursing home.

 

Hospice Medicare Benefit:

  • Room and board in a nursing home is NOT covered when the patient is receiving Routine or Continuous Care levels of care.

  • Room and board is covered during a short period of time when a patient is receiving the  General  Inpatient  Level of  Care  that requires  frequent  medical staff monitoring and active measures to relieve symptoms.

  • Room and board is covered when the patient receives Respite Level of Care for up to five (5) days.

 

Medicaid:

  • If room and board is covered by Medicaid, the patient is still responsible for the patient liability amount due to the nursing facility.

  • Should any change be made in this policy regarding services or charges, you or your responsible party will be advised. Please call our office if you have questions about charges or insurance billing.

 

 

Patient Travel Arrangements:

If you are receiving care under the Medicare Hospice Benefit and travel out of the Adya Hospice & Palliative Care’s service area, we may be able to arrange for hospice care at your travel destination.  We will try to assist with arrangements, and will require advance notice of at least two (2) days. If you are not covered under the Medicare Hospice Benefit, you will need to speak with your specific insurance company to determine how they support patients during travel.