Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
DECEMBER 1998 NICA NEWS
QUESTIONS AND ANSWERS
Q. My spouse goes to therapy everyday at the local rehabilitation center, but he has a feeding tube and a catheter. Please tell me why the Home Health Agency is saying Medicare won't cover the nurses to come in and give the care as needed because he is not "home bound"?
A. "Home Bound" is defined as being confined to the home except for infrequent or short absences or trips for medical care. While being home bound you must require a skilled nursing service.
Therefore, the patient will not receive home health care under the Medicare Guidelines because of being able to go out everyday to a rehabilitation center.
Q. What is a "private contract," and what does it mean to a Medicare beneficiary who signs it?
A. "Private contract" is a contract between the Medicare beneficiary and a physician or other practitioner who has "opted out" of Medicare for all covered items and services he or she furnishes to Medicare beneficiaries. In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner and to pay the physician without regard to any limits Medicare would normally impose on what the physician or practitioner could charge.