You Have the Right to Choose Your Home Health Care Service Provider

Federal hospital law guarantees a person’s right to choose the home care provider that he or she wants in their home following discharge from a hospital. This is an important health care right and we understand how difficult this decision can be.

There are many options available for obtaining care, and we respect your right to choose the services that meet your unique home care needs. If you are being discharged from a hospital, the Discharge Planner should work with you and your family to understand your individual home care needs based on your condition

The ability to choose your home health provider can depend on various factors, including your location, your healthcare needs, and your health insurance coverage. Here are some situations where you may or may not have the option to pick your home health provider:

1. Medicare and Medicaid:

  • Medicare: If you’re covered by Medicare and need home health services, you generally have the freedom to choose a Medicare-certified home health agency that provides the services you require. Medicare provides a directory of certified agencies, and you can select one that is suitable for your needs.
  • Medicaid: Medicaid coverage for home health services varies by state. Some states allow beneficiaries to choose their home health provider, while others may have preferred providers or require you to use an agency within their network.

2. Private Health Insurance:

  • If you have private health insurance, such as a PPO plan, you may have the flexibility to choose your home health provider. However, it’s essential to check your policy’s specific terms and network restrictions. Using an in-network provider may result in lower out-of-pocket costs.

3. Managed Care Plans:

  • If you’re enrolled in a managed care plan, such as an HMO, your ability to choose a home health provider may be limited to those within the plan’s network. You may need a referral or authorization from your primary care physician to access these services.

4. Physician Recommendations:

  • In many cases, your primary care physician or referring specialist may recommend a specific home health provider based on your medical needs. While you can express your preferences, their recommendation is often an essential factor in determining your provider.

5. Availability and Location:

  • Sometimes, your ability to choose a home health provider may be influenced by their availability in your area. Limited provider options or availability can restrict your choices.

6. Emergency Situations:

  • In urgent or emergency situations, you may not have the opportunity to choose your home health provider. The provider dispatched to your location may be determined by the circumstances.

7. Insurance Coverage:

  • Your insurance coverage, whether it’s Medicare, Medicaid, or private insurance, plays a significant role in your ability to choose a home health provider. Be sure to review your insurance policy or contact your insurance provider for guidance.

It’s essential to communicate with your healthcare provider, insurance company, or case manager to understand your specific options for selecting a home health provider. They can provide guidance on available providers, coverage, and the necessary steps to access the services you need.