Balinsky W
New School for Social Research, New York, New York 10011.
Rev Infect Dis. 1991 Jan-Feb;13 Suppl 2:S193-5. doi: 10.1093/clinids/13.supplement_2.s193.
Reimbursement policies of third-party payers, including Medicare, reflect a variety of coverage patterns. For a limited group of Medicare patients who are, in Medicare terms, confined to home and require skilled and intermittent care, Medicare Part A covers home care services deemed medically necessary by a physician. Medical equipment and supplies may be included under this coverage. Medicare Part B covers physician services, laboratory tests, and drugs used by out-patients. The latter must be administered directly by a physician or by an employee of a physician with direct supervision by a physician. These restrictions have, in general, prevented reimbursement by Medicare for iv antibiotic therapy in the home. Medicaid, Blue Cross/Blue Shield, various commercial insurers, and health maintenance organizations usually cover iv antibiotics, but in many cases prior approval is necessary for coverage.
包括医疗保险在内的第三方支付方的报销政策反映了多种覆盖模式。对于一小部分在医疗保险范畴内居家且需要专业间歇性护理的医疗保险患者，医疗保险A部分涵盖医生认为医疗必需的居家护理服务。此覆盖范围内可能包括医疗设备和用品。医疗保险B部分涵盖医生服务、实验室检查以及门诊患者使用的药物。后者必须由医生直接给药，或由在医生直接监督下的医生雇员给药。总体而言，这些限制使得医疗保险通常不报销居家静脉注射抗生素治疗费用。医疗补助计划、蓝十字/蓝盾、各类商业保险公司以及健康维护组织通常涵盖静脉注射抗生素，但在许多情况下需要事先批准才能获得报销。
