You may wonder how does a patient get Ostomy supplies covered when on service with a Home Care Agency. Depending on the patient's primary insurance, the patient may be required to either obtain supplies through a medical supplier or through the home care agency. This is based on how services are authorized for a patient's episode of care. Sometimes all supplies and visits are paid as a single sum to an agency or sometimes each part of care is authorized on its own. Please review the following scenarios to help understand the patient's current options.
Medicare
If the patient's primary insurance is Medicare, the home care agency is responsible for supplying these items to their patients. They receive a lump sum that the are to budget over the episode of care which includes supplying ostomy supplies. So if the patient has home care services, they need to contact their nurse or case manager regarding supplies. Medicare will not pay an outside supplier during an episode of care. However, keep VPC in mind as a local provider when the patient is discharged from Home Care.
Aspire Health Plan - Non-Commercial/Medicare
If the patient's primary insurance is Aspire Health Plan, the home care agency is generally responsible for supplying these items to their patients. They typically receive a lump sum that the are to budget over the episode of care which includes supplying ostomy supplies. So if the patient has home care services, they should contact their home care nurse or case manager regarding supplies. Aspire Health Plan will not pay an outside supplier during an episode of care if supplies are included as part of the episode of care. Do not hesitate to contact us to check for you if it is uncertain. Keep VPC in mind as a local provider when the patient is discharged from Home Care.
Medi-Cal
If the patient's primary insurance is Medi-Cal, the patient is allowed to use a medical supplier such as VPC to obtain their ostomy supplies while on service with a home care agency. Typically each part of care is authorized independently, thus while the home care agency gets approval for patient home visits the medical supplier can obtain approval to supply the patients ostomy supplies.
Private Insurance
If the patient's primary insurance is a private insurance, the patient should contact their insurance carrier to find out how supplies are covered during a home health episode. Some policies are like Medicare where the agency negotiated to provide all aspects of ones care including supplies while others are like Medi-Cal and are treated independently whereby the patient needs to find an in-network provider. **Unfortunately, VPC is out-of-network as the private insurance carriers claim there is too many providers in our area.
Some bad news for Monterey County
Coastal TPA/Commercial Aspire/Blue Cross
For patients that have Coastal TPA or Commercial Aspire, they will need to find an in-network provider. Please contact Coastal TPA whom will hopefully help. Coastal TPA uses Anthem Blue Cross' network whom does not wish to contract with new providers.