Limitations

  • Claim limits and changes to the IHC Policy will be determined annually by the County IHC Board. Most services will be reimbursed at the 77% ratio, except for in-patient hospital services, physician reimbursement, and oxygen services through the participating Home Health Provider. There is a $100 billed amount limitation. There is a $15,000 fiscal year limit for hospital services and a $5,000 fiscal limit for ambulance service. (This is per patient and amounts can not be transferred from one patient to another.)
  • Primary Care Services to an eligible individual will be subject to a limit of $4,000 per patient per fiscal year. (Primary Care co-pays are not eligible because they are considered reasonable and generally result after the Medicare reimbursement.)
  • The limit for Substance Abuse is one in-patient treatment per fiscal year up to $9,000. Limit for Mental Abuse (includes suicide claims) is $10,000 per fiscal year.
  • Limit for pregnancy related treatment is $10,000 and only one pregnancy is allowable per patient.
  • Home Health Services are limited to $9,000 per fiscal year.
  • Hospice treatment has a limit of $9,000 per patient per fiscal year.