Alexandra

Do you know what Long Term Care Insurance is? It can be a crucial policy for you.

It might be hard to imagine now, but chances are you’ll need some help taking care of yourself later in life. The big question is: How will you pay for it?

Buying long-term care insurance is one way to prepare. Long-term care refers to a host of services that aren’t covered by regular health insurance. This includes assistance with routine daily activities, like bathing, dressing or getting in and out of bed.

A long-term care insurance policy helps cover the costs of that care when you have a chronic medical condition, a disability or a disorder such as Alzheimer’s disease. Most policies will reimburse you for care given in a variety of places, such as:

  • Your home.
  • A nursing home.
  • An assisted living facility.
  • An adult day care center.
  • Durable Medical Equipment, such as our Medical Alert devices.

Considering long-term care costs is an important part of any long-range financial plan, especially in your 50s and beyond. Waiting until you need care to buy coverage is not an option. You won’t qualify for long-term care insurance if you already have a debilitating condition. Most people with long-term care insurance buy it in their mid-50s to mid-60s.

Whether long-term care insurance is the right choice depends on your situation and preferences.  Consider finding someone who is a financial specialist when shopping for this type of policy.  We recommend Lynette Barbieri, financial specialist she can be reached at (732)845-0006.  She has worked with many of our clients.

Insurance Coverage for your Medical Alert Device

Insurance Coverage Procedures for STAT MEDICAL Personal Emergency GPS Safety Device

 

We always recommend contacting your primary insurance company or state Medicaid Program office to find out exactly what they cover and what documentation they require. This is just a basic outline of what is typically required.

  • Using the list of codes provided, obtain a prescription from the
  • Request a quote directly from Stat Medical.
  • Submit prescription and quote to either your case/ social worker or directly to your insurance company to make sure they will cover the Medical Alert device you have chosen.

 

***For individuals enrolled in Medicaid waiver programs, please contact us at 732-508-7800 to see if we are already on their authorized durable medical equipment provider list.

If you have any general questions, please send an email to info@statmedicalalert.net or go to the contact page at www.statmedicalalert.net

Please remember we are unable to bill Medicaid or your private insurance directly and therefore you are responsible for payment and submission of the paperwork required for reimbursement.

These devices are confirmed to be covered by: Kaiser Permanente, United Healthcare, Transatlantic Insurance, American Maritime Officers, and Select Health to name a few.

The concept of wandering was added to ICD-9CM effective with the October 1, 2000 update as an inclusion term under at code 294.11.

Prescription from Doctor: A prescription from your Physician needs to be requested and including the following information:

Name:  Exact name of the Medical Alert Device you have chosen for Wandering Prevention.

Example; MX-LOCare GPS Watch, AngelSense, Bell +, LOK8U.

Diagnoses Code

Alzheimer’s Disease (331.0)

Autism or Pervasive Development Disorder PDD (299.0-299.9)

Dementia, unspecified, with behavioral disturbance (294.21)

Intellectual disabilities (317-319)

Sub code: (See above) Wandering Code: V40.31

HCPCs: S5162 – Billing Code for Purchase

Submit this to the insurance company or state funded program with a receipt for your purchase.

Additional Codes (if needed)

Other: If denied – Use Enhanced Medical Assistive technology

HCPCs: S5199

 CPT Codes – X is HIPAA compliant code S is CPT or HCPCs code

X5012 Personal emergency response system S5160, S5161, S5162

 

S5160: Emergency response system; installation and testing S5161:

Emergency response system; service fee, per month (Excludes installation and testing)

S5162: Emergency response system; purchase only X5014 DME – personal emergency response system, Installation

The new HCPCs codes level 2 are for items not covered in level 1 coding. Try these new codes HSW is Health, Safety, & Welfare

HCPCs Code – S5160K

Units of Service – Maximum allowed based on 12 month plan

Personal Emergency Response System – install/test (HSW Only)

HCPCs Code – S5161HK Per Month

Unit of Event Personal Emergency Response System – monthly service fee (HSW only) S5161HK Per Month

HCPCs 2017 Code – E1399 Durable Medical Equipment, miscellaneous

 

Please feel free to contact us is you have any questions or feel you require further assistance.

 

PHYSICIAN SAMPLE LETTER: AUTISM ELOPEMENT (Can be used for Alzheimer’s, dementia or any other cognitive impairment)

 

NAME OF CHILD OR ADULT (DOB XX/XX/XX) carries a diagnosis , which poses certain cognitive challenges and safety risks. NAME currently attends NAME OF SCHOOL in NAME OF TOWN. If this is for an adult you can leave this part out.

NAME has a history of wandering from safe environments, including a YEAR incident where NAME wandered from LIST INCIDENT. According to Centers for Disease Control (CDC), Wandering places children and adults with autism spectrum disorders (ASDs) in harmful and potentially life-threatening situations—making this an important safety issue for individuals affected and their families and caregivers.

If given the opportunity, NAME will wander from safe environments. NAME’S wandering tendencies include goal-directed elopement, which means NAME will seek out items of interest, specifically roads and bodies of water. NAME’S history also includes fleeing incidents following a meltdown or escalation trigger.

It is for these reasons, and NAME’S history of elopement, that NAME now has a medical diagnosis of Wandering In Diseases Classified Elsewhere (ICD-10-CM Diagnosis Code Z91.83). To ensure NAME’s safety, it is medically necessary that NAME have close and constant adult supervision at all times, and that proper safeguards are in place. Safeguards may include architectural barriers, door alarms, visual prompts, and a school-wide response protocol.

A Functional Behavioral Assessment should be done to help identify root causes of NAME’s elopement behaviors. NAME must never be left unattended by any adult for any reason. Leaving NAME unattended poses serious safety and health risks.

 

Sincerely,

 

 

For more information on the wandering diagnostic code, visit http://www.cdc.gov/ncbddd/autism/code.html