bcain
06-09-2010, 06:11 AM
My insurance has been a struggle, I have a private duty nursing rider on our policy, but none of the nursing agencies in my area want to take the case. It's a large insurance company... BC/BS The agencies say they've never heard of private insurance paying for private duty care and they only take medicaid. Imagine that....medicaid pays more than my insurance will. Huh? The insurance company is trying to rectify this problem by returning to the marketing dept. to see how they planned on us being able to use this benefit, if no one in our area will take our case. One agency was willing to come out and do the assessment and to bill that to the homecare part of our insurance, but unable to provide actual shift care. They even tried to send a nurse a month later "to keep my case open" just in case the medicaid waiver was granted. I told them to close my case, as there is a lifetime cost limit on our plan and I didn't want them to waste it by coming out to do vital signs.
No one seems to know how to handle our case. The insurance company is willing to pay, but the agencies are reluctant because they don't know what to do with it. One agency said BC/BS didn't give as much reimbursement as medicaid. Therefore, they wouldn't take cases of private insurance!
So I utilized a nurse friend of mine, and the respite care allowance from Early Intervention($8/hr to help pay my friend $15/hr). She's an LPN w/pediatric exp. The agencies charge $29/hr for an LPN and $39/hr for an RN. Sarah will be out of Early Intervention come Oct. when she turns 3. Then we pay the full amount ourselves, or don't go out together for more than 3 hrs. I don't want to take advantage of a friend and not pay her what she's worth. But I'm grateful for her.
No one seems to know how to handle our case. The insurance company is willing to pay, but the agencies are reluctant because they don't know what to do with it. One agency said BC/BS didn't give as much reimbursement as medicaid. Therefore, they wouldn't take cases of private insurance!
So I utilized a nurse friend of mine, and the respite care allowance from Early Intervention($8/hr to help pay my friend $15/hr). She's an LPN w/pediatric exp. The agencies charge $29/hr for an LPN and $39/hr for an RN. Sarah will be out of Early Intervention come Oct. when she turns 3. Then we pay the full amount ourselves, or don't go out together for more than 3 hrs. I don't want to take advantage of a friend and not pay her what she's worth. But I'm grateful for her.