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No doubt Hospice has come to rely on the insurance just as the medical folks have. But they never charged my dad a thing, and they were there to do everything. As soon as we put dad on Hospice they provided him with a hospital bed, all his Oxygen, coordinated with us his doctor visits, they ordered and gave his medications, and, when he died on Thanksgiving Eve, they came and stayed till the funeral home was able to come and get dad at nearly 1:AM in the morning. WE LOVED HOSPICE
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fregflyer

To answer more about your post. ICU head said she was "dead" when she was brought back to ICU, which was the 23 ( she passed 29). She was on life support, because of the effects of the Sepsis. Here is what Sepsis had done

She had congestive heart failure, tacychardia, atrial fibrulation, unspecified intestinal obstruction, sepsis, shortness of breath, chronic pulmonary edema, hypotension, malig neoplasm of liver, acute kidney failure, acidosis, acute respiratory failure with hypercapnia, enterocolitus due to clostridium difficlie. This was just too much for her body to fight.

Since she was going to die, anyway, there was no need for Hospice which was used for only 3 days.
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BarbBrooklyn-Thank you for the condolences.

I know these people need to make a living. I'm not upset about that, just be honest with people, that's it.
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fregflyer and jeannegibbs

Thank you for your comments. If you get a chance, do a google search of Dr Laura K Shoemaker. She is listed on one of the bills submitted to one of the insurance companies.

Sure, hospice is different depending on the individual and maybe it's not about the money in some instances. In this case, that was definitely not the case, since there was no chance of survival. Hospice was really a waste, since my mom never regained consciousness after 5 days of treatment.
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From americanhospice DOT org:

FAQ: How is Hospice Care Paid For?
Patients with a terminal illness do not usually have to pay for hospice care.

Hospice care costs are covered by Medicare (through the Medicare Hospice Benefit), Medicaid (in most states), and The Veteran’s Health Administration.

Medicare and Medicaid:


Currently, most hospice patients have their costs covered by Medicare, through the Medicare Hospice Benefit. Learn more about the Medicare Hospice Benefit.
Medicaid also pays for hospice care in most states. People become eligible for Medicaid when their income and assets are low.
Medicaid provides benefits that are very similar to the Medicare Hospice Benefits.


Veterans’ Benefits:

The Veteran’s Health Administration also covers hospice care. If you think you may be eligible, you can read further information for veteran’s benefits.
The Veteran’s Health Administration provides benefits that are very similar to the Medicare Hospice Benefits.
Health Insurance.

Many private insurance companies provide some coverage for hospice care. Check with your insurer to determine whether hospice care is covered and under what circumstances. Among private insurers, there are variations in qualifications and covered benefits.
Individuals who do not have insurance.

If you do not have insurance coverage and cannot otherwise afford the service, a hospice may provide care free of charge or on a sliding scale basis.
This financial assistance is provided through donations, gifts, grants or other community sources. Call your local hospices to learn if they are able and willing to offer care for free or reduced cost in your case. View our contact information for hospices in your area.
Whether a patient is eligible for hospice benefits may vary depending on who is covering the cost of care. Currently, most hospice care in the US is covered by the Medicare Hospice Benefit, which requires:

patients to be diagnosed with a terminal illness, and
be 65 years or older, and
have the patient’s doctor and a hospice medical director certify that the patient has six months or less to live.
Many other hospice benefit programs follow these same guidelines set by Medicare.
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Rainmom, Hospice patients so have to pay for their care if they are not old enough for Medicare or it is not a benefit of their regular insurance. They are charged on a sliding scale depending on the services they receive and their income level. I don't know if Medicaid covers it if they are below 65. Someone else may know the answer to that.
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Jennings I believe PCGs are now required to talk about end of life care these days.
I know mine has discussed it with me in terms of whether or not I wish to continue with the many Dr visits and procedures I have been subjected to in the past year. my decision was that as I continue to improve I wished to continue and decide on a case by case decision. i was also asked by the health care care nurse who wanted to have a conversation with their palliative care team. I told her that I had no need to see them because I had worked in that discipline for ten years. so just from my experience it seems to have become usual practice to offer this option.
I am not terminal and completely understand the reasoning. I also think that other people if they are capable of understanding the benefits should be given the choice but unfortunately with the deliberate spreading of false information patients may be afraid of hospice. Our local, very good hospice, is very underutilize
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My Grandma-in-law, has actually had me thinking about this all week. Last week she went to the doctor, and he said that she needed to start thinking about her end of life options. From how she understood it (she has some O2 related memory issues) she could just check herself into the hospital at anytime, go off her medications and basically be given morphine to alleviate symptoms until she died. At this point her meds and sheer willpower are the only things keeping her alive. So I called her doctor and she was right to a certain degree, but, he is a very ethical guy and he would have to agree to have her admitted.

As for hospice, like actual hospice, which we do not have where we live for some odd reason. Yes, in some cases it is close to euthanasia. BUT, they alleviate suffering. Hospice is not about treatment, hospice is to give a dieing patient the best quality of life they can have in their last days, weeks and months.

I have watched 3 family members die in hospice care. They go above and beyond, and in many cases (for in home hospice care) family members are in charge of the medications while the nurses are away. Actually when my Grandfather was dying of lung cancer, it was my Grandma who was far to liberal with the morphine, after 3 years in agony she could not take it anymore and did not want him to be in pain. Every time he so much as moaned she gave him morphine, I would do the exact same thing if it were my husband, I should also add that she was a Registered Nurse.

I support Death with Dignity (and all fo its other names, changes by state) and feel that terminal patients should have a choice.
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My mother was on hospice seven months. Not only were we never billed one cent, hospice took over the cost of the pain meds my mother was already on, the rent for her wheelchair that we had been paying as well as the rent on the hospital bed we had also been using prior to hospice. So if it's about money - hospice save my mother money. For the record - the same was true for my father who received hospice care for three months about four years ago. I'd think my total ten months of experience dealing with hospice services should account for something in this absurd argument that a hospice patient has to pay for their care. That's just a load of crap.
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Correction of typo: Please don't claim to know more than you do, or generalize from a single experience you don't even seem to understand.
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zythrr, I really think you are doing a great disservice here by claiming things about hospice when your mother was not on hospice. None of your explanations substantiate your claim that hospice is all about money.

My daughter works in a nice assisted living facility. One long-term resident was very personable and well-liked by staff and other residents. At the end of his life it was evident to staff that he was suffering greatly. My daughter was very upset when she talked about this. The man's out-of-state son, who hadn't spent a lot of time with his father in this condition, was hesitant about using hospice services. My daughter was so relieved when he finally signed off on hospice. The old gentleman had some comfort in his final days.

zythrr, I solemnly swear to you, for my daughter was NOT about money. She was paid the same whether the man went on hospice or not. The same was true of other staff members who were really hoping to see this man on hospice.

You cannot assume and accuse that every medical person who suggests hospice or removing life support is doing it for reasons of money. And that doesn't even make sense. Wouldn't the institution make MORE money if they kept the patient around as long as possible?

Please don't claim more than you do, or generalize from a single experience you don't even seem to understand.
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Z, for whatever reason, has a very childlike view of the world. His thinking seems to go "If it is necessary, it must be free".

Perhaps he comes from a country where all is provided if you need it. For better or worse, the U.S is a capitalist democracy without universal healthcare.

It can be an enormous challenge to adjust to a new economic system. I hope he comes back to gain some more understanding.
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Barb, just what I was thinking. Understanding the basics of hospital and hospice payment and reimbursement is one of the fundamental issues to understanding how hospice operates.
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Z, you are so mis-informed about how hospitals and healthcare billing works, it makes my head spin. I don't believe there is any sense in explaining it to you, the "facts" would make no difference to you.

Again, I'm sorry for the loss of your mom.
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zythrr, the Cleveland Clinic is a multi-specialty academic hospital located in Cleveland, Ohio that is owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation. Thus, the hospital didn't "pocket" any money.

Being that your Mom was on life support, that tells me she didn't have a legal Medical directive which would have given you and the hospital her wishes in such an event. Thus the hospital needed to do everything they could to keep your Mom alive. This doesn't sound like Hospice was even used at all.
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There are formulas for payment for ptient's treatment. The hospital not the dr bills Medicare/medicaid and any insurance company. there is a agreement about what percentage the ins will pay, likewise Medicare and that is what the hospital billed. the patient is asked to pay a standard copayment which people should know in advance. For example I pay $40 for every specialist visit and the hospital or practice knows in advance how much of their bill will be paid. The Drs are normally salaried and have nothing to do with the bills. We have just received a book from Blue Cross which is our Medicare PPO telling us what copayments will be for each procedure. They also provide a list of medications that they will cover and the copayments we can expect for them. If the Ins won't pay they are not in the formulry and the patient has to either pay out of pocket or request a cheaper alternative It is not simple and many elders do not understand how it all works. In the case of hospice they will pay for all drugs related to the admitting diagnosis but not for those for unrelated conditions. For example if the hospice diagnosis is cancer they would not pay for meds for heart failure unless caused by the cancer. your area council on aging can help you understand your choices snd help you make the best choice for any supplemental insurance you choose to buy. there are also many programs in many areas that may help pay for very expensive drugs plus some pharmaceutical companies have programs for discounts for the people with low incomes.all that being said it is definitely a jungle out there and most people can benefit from assistance.
All of this billing information is sent to the patient on a regular basis at least by Blue Cross. The patient or caregiver will have all the information to question bill and use it to file at tax time if they are able to take a tax deduction. Hospital bills are rarely itemized but you can request that if you feel you have been over billed and challenge ridiculous amounts like $50 for a band aid.
By the way to be able to take a tax deduction for 2016 you must be over 65 and the expenses must be at least 7.5% of your total income. Next year the threshold is set to rise to 10% but of course that can easily change.
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Gershun

What argument? This is an informative thread. Have you heard the phrase, "Your results may vary"? That could cover how Hospice is delivered in some settings, etc.
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BarbBrooklyn and fregflyer

Yes she had full Medicare. No bills from Hospice, though again, it was handled through Cleveland Clinic. In total for all her care, before she passed the Clinic pocketed close to $250K. Care facilities your loved ones used may not be all about the money, Cleveland Clinic and its facilities definitely are.

Unrelated to hospice, but to prove my point. A bill from the Clinic for $500 arrived. It is the difference from what the Clinic charged and what insurance may/will pay. In this case the bill the Clinic sent to insurance is a little under $28,000

Get this, her Mychart account has been disabled, but the My Account is still active. All about the money.
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vstefans

Not if it is in some hospitals and Medicare is footing the bill. If there is no chance of survival, the hospital, to keep Medicare bills low and Medicare happy, will subtly or not try to convince survivors to let their loved ones go.

As I mentioned, the ICU head, used this to try to get my mom off life support. He even was disappointed when I mentioned to see if she would pull through for one more day. I went the following day to see her, saw how she was and made the painful decision to end life support. You should have seen the sense of relief on his face regarding the decision. He came to her room even while I was talking to the Hospice doctor, quickly left and never saw him again.
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Midkid58

My intention is not to scare anyone, just be informed. The numbers are from what the hospital, etc bills the insurance and what the insurance actually paid. If you get a chance see if you can look at your mom's (and dad's) medicare and/or other insurance information. Medicare gives a breakdown on what a provider billed them, what they paid,and what the insured may be billed. She (or you) should receive statements in the mail from Medicare from time to time on what has been submitted to them and what they paid. Her other insurances, would do the same.
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BarbBrooklyn-

My mom had 3 insurances, Medicare, Aetna and Mail handlers (She was a Govt worker). It was through Mail Handlers website I found out about Hospice and the other bills to the insurance. In fact the check was made out to Cleveland Clinic and not to the Hospice doctor, though I believe she was the one that made the requests for payment.
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jeannegibbs


As explained by the ICU head, when my mom was brought back to ICU, he mentioned she had passed the day she returned. They did 5 days of medicine to no avail. I did not know about Hospice until a check of one of her insurances. He made no mention of her being on Hospice. He was only trying to convince me to take her off life support, He made mention of her age, what her body was going through and even mentioned his faith. It is probably different for some of you, but in my mom's case it was about the money.
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Knowing the little bit about hospice that I do, I know that family is around when medications are being delivered. They can request to stop them, and as long as it is reasonable, hospice will follow the wishes of the family. I am surprised when I read that a loved one was receiving medications to calm them and ease pain for several days, then died. The family knew the person was on medications, so they could have stopped them.

I personally think it is rarely euthanasia. Instead it is easing discomfort so the body can stop fighting. I've often heard that fighting pain can keep body and soul together, even after the will to live is gone. I hope when it comes my time, no one argues that I have to keep fighting pain. That would be misery. Just let me go.
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My Mom was put on comfort care her last week of life. Is that like hospice care? I don't know..............but I do know that whenever this topic is brought up again and again and again it always seems to lead to an argument.

I guess the lesson to be learned if there is one is: Ask a lot of questions if your loved one is dying. Don't leave it up to chance. Ask the doctor or nurse or whoever is administering the drugs what they are giving, how much or they giving, why are they giving it. Stay there until you get the information you want. Its too late when they have already died. If you are not happy with the care, do something about it. Then maybe we won't keep having this conversation......er, argument.
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Zyhrr, to be placed on Hospice, one would need to have Medicare Part A (Hospital Insurance).

If you are being billed, it couldn't have been Hospice but maybe Palliative Care that your Mother was receiving.

My Mom passed almost a year ago and she had Hospice. I haven't seen one bill in relation to Hospice.
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I'm really hoping Z comes back and clarifies what he's talking about.

Perhaps his mom wasn't old enough to have Medicare, or had private insurance. Those don't always cover Hospice in full. However, in this circumstance, I'll bet there is charitible support at the hospital for bills like this, but if he' s the one in charge, he needs to know to ask.
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If hospice was really all about the $$ they'd have incentives to keep everyone alive for as long as they could!
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Called my mother--Hospice cost them nothing. Zero. Paid for by Medicare. I don't know where you are getting these numbers--but you're scaring people. Hospice was provided free of charge. Mother never saw a bill.

If it's a way to make money, it's mean and cruel. Dad's dr signed off on it and he was placed in Hospice the next day. At home. Maybe if it's administered in a hospital setting--I still can't see it being about the money. Dad never saw a dr once he was placed in Hospice care. That was our experience, I am truly sorry if you had a bad one.
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Are you saying your mother didn't have Medicare?

Are you saying that you ( or family) are being asked to pay those bills?
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zythrr you said "mom had passed before Hospice was called." So your mother was never on hospice? Then what can you know about hospice billing??

Some hospice programs are run for profit and some are non-profit, but all of them are funded by Medicare.

My husband was hospice in our home for 5 weeks before he died. The bill? Absolutely none. Not in mail or electronically. No bill from hospice. Not for the doctor or the nurses or the medications or the hospital bed and other equipement. No hospice bills whatsoever.

My mother was on hospice for 3 months, in a nursing home. The regular costs for her nursing home continued, but there were NO additional charges for the hospice services. None.

Since your mother was not on hospice I don't see how you can consider yourself an expert on how they bill!!
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