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Thread: Home Health Agency delicate issue...

  1. #11
    oh yeah, I remember I visited a guy who is also a paraplegic and lives in NC. He had a smallish apartment that was chock full of wheelchairs. A power wheelchair, two manual wheelchairs (besides the one he was sitting in) and a shower chair (despite the fact that he had an accessible shower that already had a seat in it, and a toilet with a raised seat. Now I see where all that junk came from... the good ol taxpayers...

  2. #12
    Glad you got things resolved...sorry it was such a hassle though.
    Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

  3. #13
    I don't know what county you are in..some (like mine) are very limited in agencies..but I'd look for another. We had a problem similar to yours, and simply requested a change. Whoever helped you sign up with this one probably has a list..in our case it was someone from SSD.

    Some of the rules make very little sense..for instance, with Medicaid Private Duty Nursing, my son's prescriptions have a copay, and no supplies are covered..but if he only needed an aide 3 hours a day, they'd be free and many supplies covered.

  4. #14
    Senior Member Dave H's Avatar
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    You need an ILC

    I would speak to an Independent Living Center (ILC), they have been dealing with this stuff for a long time and you should have one on your side.

    Check this site for an ILC in your area.

    http://www.ilru.org/html/publication...ory/index.html
    Dave H

  5. #15
    Senior Member Dave H's Avatar
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    Sorry, I read the post too late that said you should be familiar with your local ILC anyway.
    Dave H

  6. #16
    Yeah, the amazing system. I ordered my catheter at sport aid $50/100cath. But they don't business with my bcbs, so I ordered them through Edgepark who bill BCBS $3 each. I did bring up this to the insurance company. They don't care!!!! Edgepark said because it's indiv. wrapped so they charge them indiv., not bulk rate!!!!!!!

  7. #17

    Do Not Sign the paper

    Quote Originally Posted by funklab
    Hey, I figured this forum was the best fit for my question even though its not exactly about caregiving, so let me know if I should post it somewheres else.

    Here is my situation. I just moved back out on my own (T6 complete - 8 months post) and I am on medicaid and all that good stuff, so I come to find out that the only way I can get NC medicaid to pay for my catheters and supplies is to be enrolled with a "home health" agency (I am still not sure exactly what that is, but I have one now). So I figure thats a good idea and I could use help with some stuff around the house, even though I do my own personal care, its hard for me to clean the bathroom/kitchen/etc so I will let them help me with that. (btw it all seems like a waste of some taxpayer money to me, because I would be perfectly happy to go pick up my catheters and supplies at the pharmacy, but medicaid doesnt like that, so here we are).

    So now its getting kinda sticky. The home health agency came out to my house and did an interview or whatever to assess my needs. They say "you need somebody 5 days a week for 2 hours a day"... I say "ummm, no... how bout once a week... how bout once a month, and you can just bring me my supplies." So they say okay, once a week. And then the next week the attendant (sorry if thats not the right term, but you know the person who helps ya out) comes by and says "yep, they've got you down for 5 days a week." Argh. "Well, i am not going to be here but one day a week" I tells them, and so they say thats fine just sign the paper that says they're coming 5 days a week.... therein lies the problem.

    I dont want to get in trouble for signing something that says they're doing things that they are not actually doing, but I also dont want them to drop me, or to piss off the person who is coming out to help me out around the house. Anybody got some advice about how to approach this with some tact (i've been known to lack that from time to time) and without pissing anyone off or anybody getting in trouble?

    thanks,
    Find another agency that is cooperative temporarily until you can hire a private caregiver. Do a backgound check with the State Patrol, or FBI nationwide search. You can find a caregiver on craigslist, or the paper in the service directory in situation offered. I know about this because I have been in the healthcare industry since 1984. God Bless, Be careful

  8. #18
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    Quote Originally Posted by joviliz
    Yeah, the amazing system. I ordered my catheter at sport aid $50/100cath. But they don't business with my bcbs, so I ordered them through Edgepark who bill BCBS $3 each. I did bring up this to the insurance company. They don't care!!!! Edgepark said because it's indiv. wrapped so they charge them indiv., not bulk rate!!!!!!!
    If you read the statement you get from the insurance co tho, they probably only cover them at $1 ("reasonable and customary"). Thats what mine does. Then my co-pay (I pay 20%) is based on the $1, not the $3.

    But you are right ,why do they even do it that way?

    And I started with Edgepark, b/c I used to have BCBS, and that was the company I they said I had to use! So I am sure they wern; t paying $3 a pop. I never saw the paper work tho, as with bcbs is was 100%, and they only send out statements that involved co pays.

    (In all defense, except for the crazy billing, which doesn;t hurt me, I have had great service from Edgepark. Supplies are always shipped, exactly as needed and always on time.)
    T7-8 since Feb 2005

  9. #19
    Supplies and costs are a PITB, they're two to three times the cost for anything medical and with insurance. I agree with sjean that they likely do a discount, but that just means you're using dollars faster than needed.
    C2/3 quad since February 20, 1985.

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