What is the Hospice Medicare Benefit?

 The Medicare Hospice Benefit is primarily a home care program (under certain circumstances covers hospice inpatient/acute care, hospital, and respite care).

Home is wherever the patient resides. A patient may receive hospice care while in the acute care facility if the hospitalization is for a condition not related to the terminal illness.

Hospice care is available as a benefit under Medicare Part A. It is for patients with a limited life expectancy, and is the single source of all health care related to the terminal illness.

Under the Benefit, beneficiaries elect to receive non-curative treatment and services for their terminal illness by waiving the standard Medicare benefits for treatment of a terminal illness. However, the beneficiary may continue to access standard Medicare benefits for treatment of conditions unrelated to the terminal illness.

What is Covered?

• Hospice physician services
• Skilled nursing visits – average of 2-3 visits per week & 24 hour services
• CHHA / Homemaker / Hospice Aides
• Trained volunteers
• Drugs, equipment & medical supplies (must be related to terminal illness)
• Respite care
• Social work
• Chaplain
• Bereavement counseling
• Therapists as needed

We at Avalon Hospice & Palliative Care are committed to providing comfort, dignity and hope through professional staff, which are sensitive and understanding, filled with compassion, to apply state of the art pain management skills to control and manage symptoms, one patient at a time, regardless of their race, color, gender, or nationality.

All our services are based on the needs of care. We believe and treat each patient, as one of our own family member. We will support and serve the families of each patient we will help them understand how to cope with their pain and grief. This is Avalon Hospice & Palliative Care.

Billing Information

To simplify the billing process, an Avalon Hospice & Palliative Care representative will ask for and verify a patients current insurance information when he/she is admitted to our hospice program. If a co-payment or deductible is due at the time, the patient will receive a notification letter from our patient Accounting Department with your fee determination with in thirty (30) days.

When patients are receiving services, Avalon Hospice & Palliative Care will bill their insurance company. In most cases, the insurance company will pay us directly; however, not all insurance plans provide full coverage for hospice and palliative are and some services may no be covered under the patients plan.

If we receive notification from the insurance company that a portion of services are not covered, the patient will receive a statement reflecting the balance due to Avalon Hospice & Palliative Care. Payment is due within 30 days of the statement date. In the event that a patient is not able to make a payment, they can call Avalon Hospice & Palliative Care at (858) 751-0315.

If an individual does not have health insurance, a financial advocate will contact him/her to arrange for a financial assessment in order to identify and obtain coverage for hospice and palliative services. Patients and family members are encouraged to call Avalon Hospice & Palliative Care regarding obtaining assistance by call in (858) 751-0315 Monday through Friday, 8:00 AM to 5:00 PM.

Discharged from Care

The ability of hospices to discharge patient is limited to situations in which the hospice is unable to serve that patient, or if the hospice team determines that the patients prognosis has changed. Patients may voluntarily choose to leave the hospice program at any time. Hospice staff will assist the patient and their loved ones to obtain the necessary resources in the home before discharge occurs to ensure the patients are being met.

For more information about Medicare health plans, or to receive a Medicare handbook,
call 1-800-MEDICARE.

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