In-Home Ivs In A Small Town

[Rachel]

Does anyone have Medicare, live in a small town, and receive IV fluids in-home? If so, I need some help!

When I lived in Louisville, Kentucky, I used to get IV fluids in my home 3 times a week. I have Medicare for insurance, and the billing/payment from Medicare was never a problem. They paid for the in-home health care, IV fluids, and all of the supplies 100%. It was so helpful to have the IVs in my home when I needed them and not have to use precious energy to go out to an infusion center or ER.

Now that we're in a small town, I have not been able to get in-home IV fluids. Everyone tells me that Medicare doesn't pay for them. I called my old home health agency in Kentucky to make sure that the Medicare rules hadn't changed in the past year. They said that as long as the billing comes from an agency that is contracted as "home health" that Medicare will pay for the IV fluids and supplies.

In Louisville my home health agency was a big one. They had their own nurses, IV nurses, pharmacy, etc. So maybe that is the difference? The home health agency bought the IV fluids and supplies from the pharmacy, and then they billed Medicare for them. It all worked out so perfectly.

I had to go to the ER twice last weekend for IV fluids. I'm glad that I have that option, but it is physically exhausting to go out when I'm doing that poorly. Plus, it costs twice as much to get the fluids in the ER!

Does anyone know if there is a way to make this work with a small home health agency? Does anyone have experience with Medicare and in-home IV fluids in a small town? I'd appreciate any helpful tips if you've been through this experience and know a way around it.

[FarmerAmy]

I have received IV fluids in my own elaborate way. My doctor wrote a prescription and I got all the IV supplies delivered through Walgreens Infusion Services. Then my friend, who is a home health care nurse, administered the IV. Not sure if that helps at all, but that's the way I got it to work for me.

Would it be worth looking into getting a port?? I wonder if that would make the logistics easier for you?

[Rachel]

Thanks for the reply, Amy. Do you have Medicare for insurance or something else?

It seems to be Medicare specifically that the pharmacies and home health billing people don't understand. They said that Medicare would pay for the IV supplies, but not the saline or a pump. Although I know that these were covered for me when I lived in Louisville. It just has to be billed properly. It's frustrating because I'm just a patient. I know that Medicare has paid for this for me in the past, but I don't write the billing codes or anything like that. I can't actually show the agencies how to bill Medicare and get coverage.

My husband can start IVs for me, so even if my home health nurse can't come, if I just have the supplies he could get an IV started for me. The hospital isn't even a mile away from our house, so I'm very thankful for the short trip. It would just be very beneficial if I could stay indoors, especially in the summer when it is 90 degrees out. It takes me 4-5 days to recover from brief exposure to heat, which pretty much cancels out the benefit of the IVs.

[FarmerAmy]

I am self employed and have crummy insurance, so I pay for many of my medical expenses out of pocket. I need to look into Medicare--I think I might qualify.

I'm glad the IVs are helping you! I did 4 or 5 of them in December and the only difference was that I had to pee a lot more!!

[yogini]

Rachel, if you are in a different state now, the rules and benefits might be different....even though Medicare is a federal program. Confusing, I know! I hope you are able to find a way to get the home IVs.

[E Soskis]

I don't live in a particularly small town - population 200,000+ - but, there is currently no home health agency or any other health agency that will supply home IV fluids. About a year ago, there was one private agency that ordered cases of IV fluids for me (with a prescription) and I was able to hang my own IV's at home or at work. Now that agency folded and there is no other one able or willing to do this. In fact, most insurances in this area will not even pay for home health from the hospitals to hang home IV's, antibiotics, etc... I think it is so ridiculous to be required to check into the ER just to get a liter or two of IV fluid. It seems like the additional costs associated with an ER visit would encourage insurances to pay for home IV fluids and supplies - it would be so much cheaper.

[arizona girl]

I don't live in a small town and I have aetna insurance, but when I needed to find a home health agency, I contacted the neurologist I saw near by and asked who they used for their home health infusions. Sirona is who they use and they have been great.

Maybe ask your local doctors or even the hospital who they use for home health when they discharge their patients who still need assistance.

[Rachel]

Thanks for the feedback, everyone! I appreciate you taking the time to help me out! Getting IV fluids with Medicare is so tricky. I still haven't figured out a solution, so I'm continuing to go to the ER. I don't like doing that on a regular basis because it costs Medicare twice as much as in-home IV fluids, plus it gives extra work to nurses in the emergency room for something that isn't a life threatening emergency.

My fluids were previously paid for by Medicare part A, which covers home health costs. Medicare part A is the same in all 50 states. Medicaid changes from state to state, but Medicare is the same, so fluids should still be available in home.

I called my old home health agency from Louisville to ask about how to get in-home fluids with Medicare. From what I understand, Medicare won't reimburse a pharmacy for the fluids and IV supplies, but they will reimburse a home health agency for them. So the home health agency has to buy the supplies from the pharmacy, and then home health bills Medicare. It makes for extra work for the home health agency, but that's how it is supposed to be done. It's a process that isn't well understood here in small town MN, I guess. I'm the only patient around who needs this type of care, so it's not something the home health agencies are used to.

There are only two home health agencies that provide services here, and one of them doesn't do peripheral IVs at all. So I only have one home health option. It's a town of 2,000 people, so we're pretty limited!

We have a fabulous medical center and hospital for such a small town, so I'm very blessed in that way. The medical center is connected to the hospital, so my doctor is often able to come see me when I'm in for fluids.

If anyone ever finds another way to get IV fluids with Medicare, please let me know!

[arizona girl]

Hi rachel, I hope the one home health agency can do the iv's for you. How you described how the home health company works to get the fluids, is exactly the same way they do it for my regular atena insurance. They get my ivig from the a pharmacy and then bill my insurance for meds and home health services.

The pharmacy part is partly how the home health agency gets paid, as they pay wholesale to the pharmacy and bill the retail price to the insurance company. It is the main way they cover the cost of providing home health services. This is still cheaper then the er though. So don't feel bad about the cost, this is the business model for home health and the insurance companies know that.

Glad to see your up to posting .

[ACsMom]

My dd tried the saline IV therapy, it worked and she now has a port. The home health nurse taught her how to access it and she's independent with it. The home health agency is 1 1/2 hours away. They started by sending someone out to deliver to us. Recently, they have been FedEx'ing things to us, even saline. The doctor ordering the IV's is the one who connected the agency with us. The agency does not have home health nurses but they contracted an agency that does. That agency came out here (1 hour away) for the peripheral IV's. With the port, there is only the need for supplies and those can be shipped to our door.

[Rachel]

ACsMom,

That's great that an agency an hour and a half away is willing to help your daughter! I called agencies half an hour away from us, but they don't come this far.

Does your daughter by any chance have Medicare for insurance? Supplies shipped to my home would work perfectly well. My husband can start IVs, so we don't even need a nurse. We only need the supplies! It's just seems to be impossible right now to get them.

[ACsMom]

Rachel, my understanding is that my home health/pharmacy provider is a subsidiary of Divata which is a large company. I wonder if by contacting them, you'd be able to find one of their subsidiarys or if they could take a prescription from your doctor and ship to you. The supplier/agency/pharmacy is available 24/7.

http://www.davita.co...asked-questions

That is a wonderful hymn you've quoted! Our soul anchor.

Addition. Here is another good page from their website.

http://davitarx.com/

[Rachel]

Thanks so much for that information, ACsMom! I'll have to look into this company and see if they are able to provide services for Medicare patients in my area.

[Miriam Poorman-Knox]

You can get it from the hospital pharmacy however. Let me know.

[kitt]

This may not be helpful, but we used to give our dog saline injections daily...We'd hang the saline bag, (the exact same ones they use on humans), and administer half a bag a day.

We bought the saline bags by the case through a local pharmacy, as well as the tubing and needles.

I remember shopping around with different pharmacies, and the price was remarkably different at different pharmacies.

Our dog had juvenile renal disease, and we did this everyday for well over a year. He was very patient about laying and taking the infusion.

Here's a blog I found about a girl who has been through the saline 'hoops' and is now looking at giving herself subcutaneous saline at home.

When we gave out dog Sub-q (subcutaneous) injections, the time it took to administer the fluids depended on the size of the needle. The larger the gage of the needle the shorter the time.

We could give him half a bag of saline in about 30 to 45 minutes.

Not suggesting anyone run out and 'do' this, but with port, it could be very easy, (and no needles).

Here's the blog...She refers to ME. ME is another word for CFS. In England they call CFS ME. ME stand for myalgic encephalomyelitis. Same disease as CFS. We just have an incredibly offensive name for it in the U.S. CFS is not about fatigue, it's a neuro-immune disease. Calling it Chronic Fatigue Syndrome is like calling Parkinson's Disease 'shaky person syndrome!

Blog site, with other links to saline injections...

http://www.sarahsworld.me/2012/03/nitty-gritty-on-saline-ivs-pots-me.html

[arizona girl]

I'd forgotten, I also did this for my pkd cat. Had to give her daily subq infusions daily. I bought the bags from a local pet pharmacy. I however am a difficult stick myself when it comes to an iv catheter a human needs to get the infusion.

[chicago58]

your post is so perfectly timed. i have been banging my head against the wall with medicare since oct. the company i was useing refuse to bill medicare for the equipment . lines, badages, dressing changes for the p.i.c.c. line. and charged me cash 47.00a day 3 days a week. i finally decided they were not going to bill medicare or even try to work with the doctor so i had to discontinue in home care.

but the things i know so far is the Dr. has to state that you are homebound by medicares definition.supposedly they do not cover hydration. technically we are not getting hydration because we drink enough and our blood work does not say we are dehydrated. it has to do somehow in the wording and diagnosis of the doctor.wording the fluid like they are a medication to keep our heart rate low enough. he still hasn't got that right yet. according to my h.i.c.a.p helper we are supposed to be covered if an infusion pump is used.

so the thing i was banging my head against the wall that made no sense and will never make sense is that they were covering the nurse you do have to have a nurse involved, at least once a week to **** your medical condition and report back to the ordering Dr.. they were covering medicare part D the i.v. infusion fluids. but they were not covering the i.v. lines the p.i.c.c. line dressings the saline and heprin flushes or anything else considered equipment which came to 47 bucks a day. so they cover the nurse they cover the fluid but they not covered the means to get the fluid from the bag to the body. go figure that one. makes no sense to me. so i am still fighting to get it covered. i was told today that if i am using an infustion pump , which could easily be justified since i have 2 lumens in the p.i.c.c. line. we will see i re applied today

it has been hard to go to urgent care 3 times a week. i have been blessed with the best doctor and nurses you couldn't ask for any better i love them they are so patient and wonderful to me. but i have passed out waiting, i am not the only fish in the pond during flu season. sometimes i have to wait 1-2- hours before they see me then another hour before they can even start me. since i have had to go back there i have had pnuaemonia 3 times ,some kind of virus that sent me to e.r. with 103 temp and h.r 160. a,stroke and sinus infection and i stay seperate supposedly from the main waiting room.

those are the only things i have learned so far and i should be learning alot more soon i i get qualified for medicare to pay i will tell you how i did it.

[chicago58]

my town is 40,000. all the doctors work out of an ageny 40 minutes away but the nurse she lives in our town. she is a godsend an angel. the supply company is 1 @ 1/2 hours away they are not given a choice about deliveries. most places want to forget our town exsists because we are in a valley away from all the big towns. the the company lines up all there deliveries to our town for one day a week and get really upset if you miss that day. but our area everthing requires travel so the companies have to comply if they want to keep there medicare status.

[Rachel]

Thanks for the information, everyone. I haven't found a way to get IVs in-home here, but I haven't given up on it quite yet. I would be able to get them at home if I were to pay for them out of pocket, but that gets too expensive at $75 per bag of saline.

Miriam, are you saying that Medicare will pay for me to take saline bags home if I get them through a hospital pharmacy? I wouldn't have to have the IVs administered at the hospital?

We don't even need a nurse to come. My husband can start an IV on me; all we need are the supplies. I can even start an IV if I have someone to help me. So I don't even need Medicare to pay for the nurse visit every time! The supplies are so much cheaper than an ER visit.

Chicago, it sounds like you are having the opposite problem from me! Your agency refused to bill for the supplies, which is all my agency said they could bill for. Am I understanding correctly that your part D insurance paid for your saline? That's amazing! I may need to change my Part D if that is the case. I really like my part D insurance, but I was told that they don't cover saline.

[kitt]

Rachel,

75.00 per bag of saline? We were paying 30 some dollars for a case of saline when we used it for our dog. We bought it from a local pharmacy, (I shopped around, as the price varied)....We hung the bad and administered ourselves. We didn't even need a script. I just explained we had a dog with juvenile renal disease, and they understood.

Maybe you could call Costco, (you don't have to be a Costco member to use the Costco pharmacy), find out their cost for a case and it might be worth a drive out of town to buy cases at a Costco or another pharmacy. Most pharmacies have to order saline, they don't keep it in stock.

I'm due to have a picc line put in, but am planning to have the infusions done at my local hospital when I start cardio therapy.

Good luck, I hope you find a way to make this doable! I think you will.

[Rachel]

$30 for a case?! Wow, I could afford that! The closest Costco is 4 hours away, but my husband does make a Sam's Club trip every couple of months. Sam's Club is only 90 miles away. We're in a small town in farm country, so my options are limited!

Thanks so much for the idea. I hadn't even though of buying in bulk. I will give the Sam's Club pharmacy a call!

[Rachel]

Well, I just called the Sam's Club pharmacy, and they said they can't order saline.

[kitt]

Rachel,

When we bought it by the case, we actually used a small independent pharmacy. Two of them in fact. This was almost 10 years ago, but we used 1 large bag every 2 days for our dog. He got 2 cups of saline per day, and 1 bag lasted 2 days.

We didn't buy at Costco or Sam's but I mentioned them because for people without insurance I've heard Costco has the best prices and you don't have to be a member to use their pharmacy. I've never used Costco or Sam's pharmacy.

My memory is the small 'mom and pop' pharmacies were more willing to help. Saline is very inexpensive, and I think because we were buying it by the case for over a year and a half they were willing to help. They also realized we had a real need, as you do to.

Perhaps you could Google smaller pharmacies in your town and telephone them and ask. It may be that bigger pharmacies 'don't want to be bothered' although my local Walgreen's even does compounding of bio-identical hormones now at a fraction of the price of compounding pharmacies.

Because I was able to buy by the case for a dog from two pharmacies, I feel certain you'll be able to find a pharmacy to help you. Might involve some calling around, but maybe by doing a few calls a day, you can do this.

I Googled 'saline bags for IV' and the first hit was this, and they sell it for 1.99 a bag. Of course they're too far away, but it shows you how cheap saline is! /www.bpmedicalsupplies.com/category.sc?categoryId=49

Perhaps buying it online is the way to go if you can get a deal on shipping!

Best Rachel,

K

[kitt]

I Googled 'saline bags for IV' and the first hit was this, and they sell it for 1.99 a bag.

Link I sent wasn't 'hot'. This one is Rachel. Good luck!

http://www.bpmedicalsupplies.com/category.sc?categoryId=49

[tinkerbella]

Rachel,

What ever happened about this Medicare issue? This makes me sick! This SHOULD NOT be a problem in this country! What can do about this problem? I hope you got this all straightened out. You didn't need this added stress.

HUGS