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Thread: How to Change Doctors

  1. #11
    Senior Member
    Join Date
    Oct 2011
    Location
    California
    Posts
    190
    Thanks for the advice.

    My Dad is retired so it's a Medicare Premium program, Secure Horizons -- so, according the case manager, we can be dis-enrolled in three days and switch to Medicare.

    I read the coverage book -- so, I faxed the sheet about home health agency care to the case manager because he kept insisting that there was no such thing as a 35 hour/week coverage if my Dad didn't buy extra home care insurance. Odd, the case manager at the rehab center also insisted -- after I showed her the sheet, she was surprised at the "generous" benefit and told me she would follow-up. She later told me that the insurance rep who was handling my Dad's case wouldn't call back.

    Thanks for the warning re the negotiation. I was very concerned about getting more PT for my Dad -- the case manager says that when my Dad gets home, there is a re-assessment regarding PT. When I asked about who would be responsible for asking for the re-assessment, the case manager said that he would be and would ask a home health agency to do the evaluation.

    Has this worked out for anyone?

  2. #12
    Senior Member
    Join Date
    Oct 2011
    Location
    California
    Posts
    190
    Just to let y'all know...

    I was finally able to speak directly to a rep from my Dad's HMO insurance. Regarding the 35 hours, she informed me that this is the limit and that she'll allocate 1-1.5 hours per week for home visits for my Dad -- any additional hours is subject to medical necessity and must be ordered by the Doctor.

    She claimed that this home visit benefit is also offered by Medicare. She was not a "customer-oriented" representative but instead she strongly recommended that we drop the HMO and switch to plain Medicare.

    The Case Manager left a pamphlet re 2011 Medicare - under Home Healthcare "unlimited for part-time intermittent skilled nursing care, physical, occupational and speech therapies..."

    I'd appreciate anyone's sharing of good or not-so-good experiences -- and any words of wisdom re this benefit.

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