Horizon Health and Sub-Acute Center accepts a variety of health insurances. We also participate in the Medicare benefit program, while most expenses are covered; the final costs vary depending on your individual health care insurance program. Below is an outline of general information about the costs and insurance coverage for our rehabilitation programs.
Each insurance program has specific coverage benefits. While you are most welcome to inquire about coverage with our Business Office, we strongly urge you to contact your individual insurance provider for an explanation of your benefits.
Below is pertinent information that applies to Traditional Medicare. Please note that there are additional Medicare insurance programs available to you that have different criteria than the traditional plan listed below. We recommend that you contact your insurance directly for a more detailed outline.
Traditional Medicare is a Federal Health Insurance Program for:
- People age 65 or older
- People under age 65 with certain disabilities
- People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant)
- Traditional Medicare has four parts:
- Part A (hospital insurance) Most people don’t have to pay for Part A
- Part B (Medical insurance) most people pay monthly for Part B
- Part C (Medicare advantage) Private fee for service
- Part D (Prescription Drugs Coverage)
For more information visit (http://www.medicare.gov/)
Medicare does not automatically cover nursing home care. To receive Traditional Medicare benefits in an extended care facility the following conditions must be met:
- You must have a minimum of a three (3) midnight stay in-patient hospital stay prior to admission. Admission to an extended care facility must take place within thirty (30)-days of discharge from the hospital.
- You must meet the skilled care criteria as defined by Medicare.
- The maximum number of days that you may receive Medicare coverage is 100 days. There is no guarantee that you will receive ALL 100 days. You must remain at a “skilled” level of care as defined by Medicare to receive their Medicare benefits.
"Skilled” care, as defined by Medicare, is care that requires the involvement of skilled nursing or rehabilitation on a DAILY basis. Skilled nursing and rehabilitation staff include: Registered and Licensed Vocational Nurses, Physical, Occupational Therapist and Speech Pathologists.
During an eligible beneficiary’s stay in a skilled nursing facility, payment is as follows:
- Traditional Medicare pays for 100% of the bill for the first twenty (20) days. No secondary insurance is required.
- From the 21st day through the 100th day, there is a daily co-insurance rate is adjusted yearly by Medicare. For co-insurance rates please see Financial Rates information in this web site. Medicare will pay the balance. Please note that your secondary insurance may cover this co-insurance amount. Again, we advise you to contact your insurance company directly for more information.
- If your policy does not cover the daily co-insurance, then you are responsible for the payment. The facility will verify any secondary insurance to be sure that the coverage is active.
- In the case where there is no co-insurance coverage, the facility will require PRIVATE payment of the co-insurance rate. This amount will be due beginning on the 21st day of your Medicare benefit period. If you qualify for Medi-Cal assistance and the facility participates in the State Medical Program, the co-insurance amount will be payable by Medi-Cal, however, your monthly patient pay amount will still be due.
- Other out of pocket expenses not covered by ANY insurance include personal items such as: Beauty/Barber shop services, guest meals, rental of telephone or television and wheelchair van transportation.
Medi-Cal is a State and Federally funded program that assists residents who are economically eligible pay for their nursing home costs.
For more information visit (http://www.cms.hhs.gov/Medicaidgeninfo/)
Please be advised that you may still also be asked to pay a portion of the cost for your nursing home stay known as you patient pay amount which is determined by the state of California Health and based on your monthly income.
Yes, Horizon Health and Sub-Acute Center does participate in the Medi-Cal / Medicaid program. Please note there are a limited number of beds. For more information regarding availability please contact the Admissions Office (559) 321-0883.
Hospice care is “end of life care”. We have contracts with several providers in the local area and offer a peaceful environment and specially trained staff to assist in carrying out your Hospice plan of care. We understand that this is a very difficult time for all involved.
Once you are admitted to the hospital, a discharge planner will come speak to you about your plans for rehabilitation. At that point you will need to advise the discharge planner which facility you would prefer to use for your recovery/therapy.
How do you get my information for review? Our Admission Coordinator will get in contact with the hospital discharge planner to review your medical information.
Care and Services provided:
Yes, Nurses are licensed by the State and C.N.A.’s are certified.
Our therapists are in the building seven (7) days a week. You are individually assessed upon admission to determine your personal plan of care. The therapists will determine how much therapy you will receive based on specific diagnosis, physician orders, and capabilities.
On admission day or within 24 hours the therapy department will complete a therapy evaluation using information provided by the hospital, your family and yourself. They will also conduct a thorough individual assessment of you. Your assessment will determine the therapy program best for you. Patients are typically in therapy anywhere from 4-7 days per week - therapy sessions run from 30-60 minutes each.
No. However, several physicians are in the building daily and are available to oversee your medical needs. Other ancillary physician services available include: Physical Podiatry, Eye Care, Dental, Pain Management, and Psychiatry.
Your private physician may treat you. However, your private physician must follow all facility, State and Federal regulations regarding physician care in a nursing home environment. This can be a daunting task for a physician who does not regularly visit nursing home patients and can prove to be inefficient and consequently not in your best interest. Therefore, we have several physicians that we have contracted with readily available and will provide excellent care. If, however you do still wish to be treated by your private physician at one of our facilities, we ask that you inform us of this arrangement so we can determine if your physician will follow you.
Your first day of care:
On the day of admission, the nursing staff will evaluate you. They will complete a basic assessment to determine your general condition on admission. Within 24 hours of admission, you will also be assessed by the therapy department to determine your capabilities and goals. These individual assessments will determine your individual skilled plan of care. Also, on admission day, the Admission office will need to see you or your family to complete the registration process. This paperwork must be completed at your facility of choice. Please allow at least 30 minutes for this process. The Admission office will need a copy of your health insurance cards, prescription drug card, Medicare and Medicaid cards and Power of Attorney (if applicable).
Make sure to bring your own personal clothes. Comfortable clothes are recommended along with a good pair of sturdy shoes. The therapy department will assess your need for a wheelchair or walker during your stay and we will supply you with one if needed.
During your Stay:
No. The facility will order all your medications directly from the contracted pharmacy. The hospital from which you are being discharged will provide the facility with as a list of current medications you are taking. The physician assigned to your care will be contacted for admission orders and your medications will be obtained from the pharmacy.
The front lobby hours for Horizon Health and Sub-Acute Center are from 8:00am - 8:00pm daily. However, we recommend your guests visit you between the hours of 12noon - 8:00pm, that way you're up and dressed and breakfast has been served.
Meals and Dining:
Our menus are prearrange, however alternatives are always available at lunch and dinner. Once you're admitted to our facility, a Dietary Representative will visit you. Please make your food dislikes, allergies, and general food preferences known. This will notify the Dietary Department what types of foods you would prefer. Every effort will be made to meet your dietary preferences.
Yes. Horizon Health and Sub-Acute Center does offer guest meals that are available at a cost of $4.00 per meal. Only the resident or responsible party can charge a meal to your room. We ask that you have your request into the front reception desk at least two (2) hours before the meal is to start. The meal can be served in your room or in one of our dining rooms.
Non-medical services and activities:
Yes. We do offer a laundry service for your convenience. We label all personal clothing and ask that those items be of a wash-and-wear material (no dry cleaning). Please note, while we offer this service, you can elect to have your family do your personal laundry instead.
Yes, on the short-term side. Long term care may have their families bring a small TV from home.
Horizon Health and Sub-Acute Center offers a wide variety of different activities, ranging from Bingo to Arts and Crafts to live entertainment.