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Nursing Homes
Coverage Information
Coverage for nursing home services is dependent upon the enrollee's Medical Coverage Agreement. Contact Customer Service for more information.
Skilled nursing facility care is covered for eligible Group Health members when:
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The need is determined to meet medical criteria. |
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The care has been approved by Group Health or a Group Health-contracted physician. |
The decision to admit to a skilled nursing facility is made by your physician. Admission can occur from the hospital, emergency department, or clinic. Covered skilled nursing care is usually provided in Group Health-contracted facilities.
The determination of skilled nursing facility coverage is based on your care needs. The actual length of stay may vary. Residential nursing home care (also known as long-term care) is not covered under your Group Health benefit, but physician/nurse practitioner visits are covered under the benefit.
Skilled Nursing Facilities
During your stay, a Group Health nurse practitioner and doctor team will work together with the facility to meet your medical needs. Whether your stay is temporary or long-term, this team maintains contact with all Group Health physicians involved in your care.
The Group Health nurse practitioner is a geriatric care specialist and your primary contact for medical care. The nurse practitioner has advanced training in the diagnostic evaluation of nursing facility patients and the treatment of chronic and acute medical problems. He or she will also work with the nursing and rehabilitation staff in the nursing facility to coordinate a safe discharge from the facility.
The Group Health doctor works closely with the nurse practitioner to review admissions and coordinate patient care. The physician visits the nursing facility regularly and is available for medical consultation when needed. Physicians may also meet with families or discuss patient care by telephone or scheduled conferences. The nurse practitioner can help coordinate these meetings.
Pharmacy Services
If your skilled nursing facility stay is being covered by Medicare, Group Health members will receive their medications from the facility's pharmacy. For long-term care, Group Health members with prescription benefits should know:
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Medications are paid for only when obtained from a Group Health-approved pharmacy. |
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Delivery of prescriptions is not provided by Group Health. |
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The facility's pharmacy may be able to arrange delivery from Group Health, or medicines can be mailed. |
Contact Information
For concerns about skilled nursing facilities, contact:
Nursing Home Services
Group Health Cooperative
201 16th Ave. E., CEB301
206-326-3165 (Seattle)
1-800-887-3873, ext. 3165 (Toll-free)
Medicare also provides detailed information about nursing home facilities.
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