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Why won’t insurance pay us to care for family or as live in?

I live with my best friend. He’s severe handicapped. He’s trach/vented. He requires 24 hour nursing. The insurance verbalized they will not pay for a nurse if they have the same address?? The nursing company has not given us one nurse so I can leave and go to work to get paid. This is crazy. I’m a nurse but they will only pay for another to come in so I have to go somewhere else? I feel like hiring a lawyer. What should we do?

Specializes in Ventilator/trach.

How can a person go to work? What if person requires nursing skills?

Specializes in Dialysis.
8 minutes ago, Rockinurse said:

How can a person go to work? What if person requires nursing skills?

If the caregiver works, not the patient. It's for if the caregiver can't be there or is physically unable to provide care.

When I did in home care and then was office manager, the nurse or HHA went while the caregiver was at work. They did bathing, light meals, and other ADLs for the disabled. They helped educate the caregiver how to provide care when the company was not present in the home, for nonmedical persons.

Specializes in Ventilator/trach.
On 12/5/2019 at 7:13 AM, Elaine M said:

Will they pay for 24 hour care from a nurse who doesn't live in? Why not do that?

So far he’s approved for 12 hours. They will pay for a nurse but can’t be me because I live there.

Specializes in Mental Health.

If you can get a nurse for 12 hours, why can’t you work?

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