With only a handful of states now licensing home-infusion more insurers are probing bills for padding and negotiating discounts. Consumers can further protect themselves from overcharges and other problems with a bit of common-sense sleuthing:
Check your coverage. Many patients run up huge home-care tabs only to have the insurer refuse payment or to find they have exhausted their policy's lifetime limit. Some insurers still insist on a hospital stay before approving home care. To avert billing problems, find out if your infusion service is among your insurer's approved providers and ask about limits to coverage; some insurers, for instance, will pay for only up to eight weeks of antibiotic infusion. Two heads are better than one. "A second opinion is always useful," says Health and Human Services Principal Deputy Inspector General Michael Mangano. The trick is to ensure an independent second opinion. Roughly half the states, including New Jersey and New York, forbid physicians from referring patients to home-care or other companies in which they have a financial stake. The local health department can tell you if the state has banned physician self-referral. Otherwise, the only way to ferret out any business ties is to ask the doctor.
Check credentials. The lack of national or state licensing standards -- plus a spate of bad press -- has prompted a growing number of home-infusion companies to seek industry accreditation. The consumer service center of the Joint Commission on Accreditation of Healthcare Organizations (One Renaissance Blvd., Oakbrook Terrace, IL 60181; 708-916-5800) can tell you if your provider meets the group's requirements for personnel, safety and infection-control procedures. Specify the local branch name, since many infusion companies are part of conglomerates. With a self-addressed, stamped envelope, the commission also provides a free list of questions to ask when choosing a home-care firm, such as whether a provider offers 24-hour telephone service.
Haggle with suppliers. You do not have to be a hospital or health insurer to bargain down the price of in-home care. "Call several services and ask how much it will cost," suggests Laurie Bodenheimer, home-care manager at BlueCross BlueShield of the National Capital Area, based in Washington, D.C. You may not get the 50 percent discounts many health organizations have negotiated, but most infusion firms will reduce their rates upon learning another local outfit will do the job for less. Better yet, ask your insurer to do the bargaining. Experts also advise asking whether a generic or less expensive drug is available.
Scrutinize supplies. A company's first delivery may provide more gauze, syringes and other commodities than the patient can use in a month -- all of which inflate the tab and are unreturnable. Alerting the infusion company to hold up on restocking should alleviate the excess. (Firms such as Caremark call to confirm before restocking). Caregivers should also carefully examine any medications, since even the most reliable service can deliver the wrong goods.
Watch out for swindlers. If a company tries peddling medical equipment or services directly to you as a patient, chances are you are being scammed. Most insurers require a prescription or physician's referral for reimbursement. And so does the government. "Anytime you hear the words `Medicare will pay, and it won't cost you a thing,' that should be a red flag," says Cathaleen Ahern, a program analyst in the inspector general's office at HHS.
