I have received notification that my insurance provider requires face to face visit with my physician (whom agrees that I need home care services) and that I have had that visit either 90 days prior to the start of home care services or 30 days after home care services have begun.
I understand that I am responsible to meet this requirement in order for my home care services to continue uninterrupted and I understand that if this visit is not conducted, my homecare services may be put on bold and/or I may be discharged from care.
I also understand that my insurance company may not pay for any visits that have occurred during the time period that this requirement is not met.
Patient Signature
