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Cost, Qualifying and Billing Information for Valley Hospice

Valley Hospice is a special way of caring for a person whose illness cannot be cured. The focus of hospice is on care, not cure. Emphasis is on helping the person to make the most of every moment of remaining life by providing comfort and relief from pain and symptoms. Care is provided at the patient’s place of residence and includes services not usually covered for non-life-threatening medical conditions.

What are the advantages of electing the Medicare Hospice Benefit?

  • It provides support and services to the patient and family in a team approach.
  • It gives Valley Hospice the freedom to make more frequent visits when needed.
  • It reduces the financial strain of costly drugs.
  • It reduces the financial burden of medical equipment.
  • It allows loved ones respite care when a break is needed.

How do people pay for hospice care?

Most Valley Hospice patients are enrolled in some kind of insurance program that pays for hospice care.

  • Medicare has a comprehensive hospice benefit that covers the full cost of standard hospice services and appropriate durable medical equipment such as hospital beds, wheelchairs and walkers. Medicare also pays for prescribed medications related to the patient's primary hospice diagnosis. Valley Hospice is reimbursed by the Medicare Hospice Benefit on a per diem (daily) rate.
  • Medicare HMOs are required to make hospice care available. Those enrolled in these types of programs are entitled to hospice services through Medicare, Part A. When the Hospice Medicare Benefit is elected, the patient does not give up other HMO services to receive hospice care. Patients enrolled in Medicare HMOs have the right to choose any Medicare-certified hospice program.
  • Medicaid also has a hospice benefit for patients who qualify. It pays for 100 percent of the interdisciplinary team services, durable medical equipment and all medications related to the patient's terminal diagnosis. If the patient is dually eligible for Medicare and Medicaid, approved nursing homes’ room and board will also be covered by Medicaid.
  • HMOs, PPOs and private insurance plans provide a hospice benefit in most cases. Depending on the individual’s policy, hospice services may require pre-authorization. Valley Hospice will contact the patient’s insurance on his or her behalf. Coverage is subject to policy limitations which may include deductibles and co-pays.

If a patient elects the Medicare Hospice Benefit, does the patient give up all other Medicare benefits?

Absolutely not. In order to elect the Medicare Hospice Benefit, the patient must be enrolled in Medicare, Part A. However, the patient may still use all appropriate Medicare, Part A and Part B benefits, if enrolled, for the treatment of health problems unrelated to his or her terminal illness. When standard benefits are used for conditions unrelated to terminal illness, the patient is responsible for Medicare’s deductible and coinsurance amounts.

What services are not covered?

In general, once elected, most hospice insurance programs will not pay for:

  • Treatment of services not related to the terminal illness
  • Care provided by another hospice
  • Care from another provider that duplicates care the patient's hospice is required to furnish
  • Room and board
  • 24 hour live-in caregiver

Any services outside the Hospice Plan of Care must be pre-authorized by the Hospice Team.

Billing Information for Valley Hospice:

Valley Hospice will contact your insurance for verification of coverage and authorization of hospice services, supplies, durable medical equipment and drugs.

  • Not all insurance policies cover these services. Your plan may have benefit limits, co-pays, deductibles or will deny services. The responsible party will be billed as determined by your insurance company.
  • For additional information about your insurance benefits or hospice coverage, please contact your insurance company directly or contact your employer benefits department.
  • Remember to inform your nurse of any insurance changes during your hospice services.

What about those who cannot afford to pay for hospice services?

As an independent community-based, not-for-profit health care provider, Valley Hospice accepts eligible hospice patients, regardless of their ability to pay. The goal at Valley Hospice is never to deny care to those who need it. Charity Care applications are available to these individuals.

Valley Hospice will provide hospice services in a cost effective way for our patients. If you cannot afford to pay, we offer Charity Care sliding fee schedules, payment plans and credit card payment options for your convenience.

Account Inquiries telephone numbers:

Medicare Hospice Benefit:   201-291-6000, ext. 7074
Medicaid Hospice Benefit:   201-291-6000, ext. 7467
Commercial/Managed Care:   201-291-6000, ext. 7468 or 7465
No insurance/Credit cards:   201-291-6225 or 6215
Charity Care:   201-291-6234
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Paramus, NJ 07652
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