Payment & Eligibility

Our home health care services are covered by many insurance carriers, including Medicare, Medicaid, health maintenance organizations (HMO), certain veterans benefits, workers compensation insurance, and other private insurance companies. Often, insurance will cover 80 to 100% of the costs related to home care.

When a referral is received, we verify insurance coverage and help make any necessary financial arrangements for the patient. We do not provide services to a patient without first acknowledging the cost of services; therefore, our patients are never given a bill for a charge that he/she was unaware of.

Individuals are also welcome to pay privately for these services. Please call our office at (920) 842-4132 or (715) 854-8080 for private pay rates.

Eligibility

To qualify for the Medicare HH benefit, a beneficiary must:

  • Be confined to the home;
  • Be under the care of an attending physician who is a doctor of medicine, osteopathy, or podiatric medicine and is eligible and enrolled in the Medicare Program;
  • Be receiving services under a plan of care (POC) established and periodically reviewed by a physician; and
  • Be in need of skilled nursing care on an intermittent basis (furnished or needed on fewer than 7 days each week or less than 8 hours of each day for periods of 21 days or less, with extensions in exceptional circumstances when the need for additional care is finite and predictable), be in need of PT or SLP services, or have a continuing need for OT services.

A beneficiary’s residence is wherever he or she makes his or her home (e.g., own dwelling, apartment, relatives home, home for the aged, or other type of institution). Hospitals, Skilled Nursing Facilities, and most nursing facilities under the Medicaid Program are not considered a beneficiarys residence under the HH benefit if they meet the requirements under Sections 1861(e)(1) or 1819 (a)(1) of the Social Security Act (the Act).

For a beneficiary to be considered confined to the home, leaving home requires a considerable and taxing effort. The beneficiary may be considered homebound if absences from the home are infrequent, for periods of relatively short duration, or for the need to receive health care treatment. In general, a beneficiary is considered homebound if leaving home is medically contraindicated or he or she has a condition due to an illness or injury that restricts the ability to leave the place of residence except with the aid or assistance of:

  • A supportive device (e.g., crutches, cane, wheelchair, or walker);
  • Special transportation; or
  • Another person.

Other insurances

Eligibility requirements for Medicaid, VA, and other private insurances vary. Please call for eligibility requirements specific to your insurance.