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Phillips Esq.
Phillips Esq., Attorney-at-Law
Category: Consumer Protection Law
Satisfied Customers: 19331
Experience:  B.A.; M.B.A.; J.D.
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There seems to be a break down between the left and right

Customer Question

There seems to be a break down between the left and right hand and I am trying to understand the medicare system as we deal with a sick family member. We have an ALS patient who, due to muscle paralysis is essentially a quadriplegic. He requires assistance 24 hours a day as he us unable to put on or take off a required breathing machine and he frequently chokes on saliva. He is also on a feeding tube and receives physical therapy. I have spoken to medicare and they say that they allow up to 28, and in some cases 35 hours a week of a home health aid provided he meets the criteria (he does) however, none of the medicare approved home health aid companies bill on an hourly basis and they all say medicare will never pay that way. I have a specific example that covers this exact type of case as item 50.7.1 -on under intermittent care (Page 86). Why has no one ever heard of this being provided. Is medicare listing a service as available to members and then never allowing it? That seems fraudulent. If it is allowed, how do we claim the benefit? Do we risk being denied after the care is provided (and we are therefore left with an unpaid bill)? The family is attempting to keep him at home as he is unlikely to live for much longer, but they all work and are trying to juggle their work schedules to provide coverage. If we could get some coverage paid for, it would help greatly. To complicate matters, the patient is a former 6 year National Guard member and a DOD employee who did two tours in Iraq. Because his training time does not count as active duty, and his tours were listed as a civilian, he does not quality for Veteran benefits (ALS is considered a service related disease for veterans with a certain number of active duty days.) He has been denied benefits, despite an equal exposure, due to that. Thank you for your time.
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  Phillips Esq. replied 1 year ago.

You would need to contact Medicare again and tell the claims specialist the kinds of problems that you are running into with the providers about hourly billing. I am sure that the claims specialist would tell you how to submit the claim in order for the bills to be made. Generally, the bills are sent as days of services provided and not hours.

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