Humana Senior Bridge

fbesn · May 28, 2014

I don't know of any patient's with HUMANA who have had a Senior Bridge nurse. There may be plenty, I just don't know any. For the most part, a Medicare Certified Agency would send a nurse and this would be covered by Medicare (of course), but not in the role of the Senior Bridge Care Manager. It's a very different role. The Senior Bridge nurse is a "consultant / care manager" for the family, the homecare nurse is hands on. Medicare does not pay for a "care manager."

olive11 · Dec 5, 2014

I believe the Care Manager role was created by Humana to help control costs by diminishing the number of patients returning to the hospital within the first 30 days of discharge from a hospital or rehab facility stay. Since Medicare frowns upon re-admits of patients to the hospital within the first 30 days after discharge, they can refuse to pay for readmissions and can even order an audit of the patient's records to find out why the patient would need to be re-admitted. All of this can add up to big charges for the insurance company carrying the patient. The care manager is there to be a patient advocate of sorts and to help with patient concerns and needs without actual hands-on nursing. I don't know who pays for it, but I do know that the patient (member) has to be qualified for the care manager program. There is criteria they need to meet (diagnosis, prognosis, recent medical history) as well as what is in their particular insurance plan.

fbesn is correct. Medicare doesn't pay for care managers. This would have to a covered benefit offered by the insurance company. Since Humana offers Medicare plans within the Humana system, this is how they are able to offer the care manager benefit and are still subject to Medicare oversight.

mrspab · May 24, 2015

Have you any experience working for SeniorBridge?