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Nurses   (729 Views | 15 Replies)

Rockinurse is a LPN, EMT-B and specializes in Ventilator/trach.

161 Profile Views; 9 Posts

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?

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341 Posts; 1,851 Profile Views

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

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RNNPICU has 13 years experience as a BSN, RN and specializes in PICU.

1,057 Posts; 12,333 Profile Views

Lawyer likely will not help as it may have something to do with Medicaid/Medicare reimbursement laws created by the state. Also, as a nurse, it is impossible to work 24/7 on a continuous basis, who would your relief be, who would fill in for you when you are sick, need to go grocery shopping, leave the house for other errands, vacation, etc. Most cases like your friend although may require 24 hour care, may not require 24/7 nursing care.

How would you draw the line between your nursing obligations to care for him and when you are off duty? If the nursing company has not given you a nurse, consider switching companies. 

Check with your state laws on non-family person who shares and address.  If you were a family member it may be a different story.

Edited by RNNPICU

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Aliens05 has 2 years experience as a ASN and specializes in IDD/Group Home.

132 Posts; 1,973 Profile Views

Would they pay for two/three nurses who don't live there and come care for him in shifts? Say they did like a 6a-6p and a 6p-6a. In that situation no nurses would have to live there. If the insurance company would pay for 24 hour care, and they just can't live there, is it possible to do it this way? 

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Rockinurse is a LPN, EMT-B and specializes in Ventilator/trach.

9 Posts; 161 Profile Views

He is allowed 12 hours a day nursing. We have been with every company in the area. The most shifts we had filled were 3 a week. The insurance is saying the other hours are “custodial”. He has severe muscular dystrophy. A quad, trach, vent, defibrillator. So needs 24 hour care. I talked to insurance yesterday. They said their medical director say we have a “close relationship “ and because we have same address and I’m poa I cannot work to get paid. 

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jupitercrash is a LPN and specializes in School Nursing.

18 Posts; 695 Profile Views

I worked as an aide for my grandpa before he died and they said the only time they do not pay for a family member to be a health care provider is when they are also the power of attorney, but they would have still allowed it if I lived at the same address. I also worked through an agency which may have helped the situation. not the exact same thing, but similar situation. 

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RNNPICU has 13 years experience as a BSN, RN and specializes in PICU.

1,057 Posts; 12,333 Profile Views

Especially since you are POA, it would be a conflict of interest. 

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19 Posts; 195 Profile Views

You’ll have to go through The department of aging. Maybe see if the state will pay for home health aide or cna care. 

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9 Posts; 298 Profile Views

Hmm my grandma gets paid to care for my grandpa. Weird. 

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Rockinurse is a LPN, EMT-B and specializes in Ventilator/trach.

9 Posts; 161 Profile Views

As a nurse or caregiver? Which state?

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Rockinurse is a LPN, EMT-B and specializes in Ventilator/trach.

9 Posts; 161 Profile Views

If I remove my poa will same address be a issue?

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Hoosier_RN has 20 years experience as a MSN and specializes in LTC, home health, hospice, ICU, ER, dialysis.

4 Followers; 1,674 Posts; 3,536 Profile Views

It varies by state. In IN, they figure if you have an adult in the home that is physically and mentally able to provide care, they should provide for free. Not sure how other states run, but if the "in home" caregiver works, those hours could be covered by services. It stinks, but makes fiscal sense. I've never heard of anyone getting in home care around the clock unless it was private pay. Not saying it couldn't happen, just never heard of a case

Edited by Hoosier_RN

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