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Redefining Quality of Life

Don’t get strong-armed. You have the right to choose your healthcare provider.

Every day we are confronted with many choices. What should I wear to work? What should I eat for dinner? Some choices are easy but some choices are difficult. Making prudent health care decisions can often times be tricky and sometimes cumbersome. But through all of the fog there is something that we must realize.

As consumers of healthcare we have the freedom to choose the healthcare that we receive and who provides that care. No one has the authority to make that decision for us or push us into a decision that we are not comfortable making. While this is true regardless of your insurance, if you have private insurance you may be asked to use an in-network provider. Note that you do typically have the option of using someone not in-network, but typically you end up paying more out of pocket expenses.

In the case of Medicare and Medicaid beneficiaries, the law states that “any individual entitled to insurance benefits under this subchapter (Medicare/Medicaid) may obtain health services from any institution, agency, or person qualified to participate under this subchapter (Medicare/Medicaid certified) if such institution, agency, or person undertakes to provide him such services.” 42 UCS 1395a(a). This law ensures that patients have the freedom to choose and the guarantee that this choice will be honored.

As a post-acute home health and hospice agency, quite a few of our patients are coming directly out of the hospital when we admit them. At the point of hospital discharge, the patient has the right to choose which agency provides their post-acute care. If the patient wants Ohio’s Hospice Loving Care and asks for us to provide their care, the hospital is obligated to honor this request without making the patient feel bad for not choosing a specific provider preferred by the hospital.

The Hospital Medicare Conditions of Participation requires that the hospital a) specifically inform patients of their right to choose a postacute care provider, b) provide a list to the patient of providers whom provide services in the area where the patient resides and c) disclose to the patient any agency on the list with which the hospital has a financial interest. 42 CFR 482.43©(3),(7).

Unfortunately, many patients coming out of hospitals are not given much of a choice, or are strong-armed by the hospital to choose a certain provider that benefits them financially. We must get the word out that people have the right and the freedom to choose.

This article was written by Christina Kennedy, Ohio’s Hospice Loving Care compliance officer.

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