 | Tom Welk
DMin is Director of Pastoral Care & Professional Education at Harry Hynes Memorial Hospice. He also teaches at the University of Kansas School of Medicine-Wichita. He has certification with the American Association of Pastoral Counselors in Clinical Pastoral Education. His memberships include Park Ridge Center for Study of Health, Faith, and Ethics, and St. Louis University Center for Health Care Ethics, Charter Board Member Kansas Health Ethics, Inc., and Ethics Committee Member for National Hospice Organization. He has received the President's Award of Excellence for Public and Community Awareness, for the "Dying Well" project from The National Hospice Organization. Tom's group presentations include: Association of Kansas Hospices, Midwest Congress on Aging, and Kansas Health Ethics Conference. Tom Welk can be contacted by fax at (316) 265-6066, by e-mail at: twelk@hynesmemorial.org, or at his office at (316)219-1791. |
Hospice
2004-01-01 10:48:00
How is hospice paid for?
: How is Hospice paid for?
ANSWER: Hospice services provided by a Medicare certified/state licensed organization are reimbursed in generally the same way as other medical services. The majority of people in our country have some kind of medical coverage: commercial insurance (e.g., Blue Cross/Blue Shield), Medicare or Medicaid. There are many (estimates range from 40-50 million), however, who do not have medical coverage. More comments about this later. The term "third party payers" is used to describe how the costs of medical care are covered in this country.Individuals who are eligible for Medicare and are appropriate for hospice (considered having a prognosis of six months or less) are covered through the Medicare Hospice Benefit. Under this benefit, the hospice organization is paid a set amount of money each day and is responsible for paying all of the costs of care related to the terminal illness. An individualized care plan is developed to meet the needs of the patient, including medications, medical equipment, supplies related to the illness, and all staff visits (hospice doctor, nurses, health care aides, social workers, volunteers, and chaplains). Included in coverage is the possibility of having chemotherapy and radiation, when necessary for symptom management. Not all hospices will provide coverage. Readers are advised to ask prospective hospice providers about their policy in this regard.Those who qualify for Medicaid (meet the financial criteria for coverage of medical care) also have a Hospice Benefit available to them. The Medicaid Hospice Benefit is basically the same as that provided by Medicare.Individuals who are not Medicare/Medicaid eligible will most likely have hospice coverage under their insurance plan. Obviously, there are many types of insurance policies. In the past most insurance coverage was based on a "fee for service" structure. Under this type of plan the insurance company pays the medical provider for the allowed service(s) deemed medically necessary. Most commercial insurers do not use this system for hospice services. They are more likely to use the same structure of reimbursement provided by the Medicare/Medi-caid Hospice Benefit. Readers need to check to see how hospice services are covered by their particular plan.What about those who do not have any insurance coverage through Medicare, Medicaid or commercial insurance (the 40-50 million uninsured)? These individuals fall under the category of "private pay". When this happens a financial assessment is made to determine ability to pay. (Providers who take any third party payment are required to do this.) Frequently, the uninsured are either unemployed or do not have insurance coverage as part of their benefit package in their place of employment. The financial assessment many times will indicate inability to pay for hospice services. Several hospice programs in this area either do not care for the uninsured or will restrict the number of such patients they will serve. Readers are advised to check out the policy of the hospice organization being considered to provide service.
