Does Fidelis Cover Home Health Care?

11 Jan 2022
Fidelis Care offers comprehensive health insurance to NY residents, including home health care services such as nursing and therapy.

Fidelis Care is a health insurance company that provides coverage to individuals and families in New York State. One of the questions that many people have is whether or not Fidelis covers home health care. In this article, we will explore what home health care is, how it works, and whether or not Fidelis covers it.

What is Home Health Care?

Home health care is a type of health care service that is provided in the patient's home. It is designed to help individuals who are recovering from an illness or injury, or who have a chronic condition that requires ongoing care. Home health care can include a wide range of services, including:

  • Skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medical social services
  • Home health aides

How Does Home Health Care Work?

Home health care is a convenient option for individuals who need medical care but prefer to receive it in the comfort of their own home.

This type of care is provided by licensed healthcare professionals who come to the patient's home to provide services. The services provided are tailored to the patient's specific needs and are designed to help the patient achieve their health goals.

Services Provided

A patient recovering from surgery may need various services such as wound care, physical therapy, and medication management. A home health care professional can provide these services to the patient in the comfort of their own home, which can help the patient recover in a familiar environment.

Home health care professionals work closely with the patient's doctor to develop a care plan that outlines the services that will be provided. The care plan is regularly reviewed and updated to ensure that the patient is receiving the best possible care.

Additional Assistance

In addition to medical care, home health care professionals can also provide assistance with activities of daily living, such as bathing, dressing, and meal preparation. This can be especially helpful for individuals who have difficulty with these tasks due to illness or injury.

Overall, home health care is a valuable option for individuals who need medical care but prefer to receive it in their own home. With the help of licensed healthcare professionals, patients can receive personalized care that is tailored to their specific needs and designed to help them achieve their health goals.

Does Fidelis Cover Home Health Care?

Yes, Fidelis covers a variety of home health care services as part of their health insurance plans. These services may include:

  • Skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Medical social work
  • Home health aide services

It is important to note that the specific services covered will depend on the plan that the individual has chosen. Additionally, there may be certain requirements that must be met in order for home health care services to be covered, such as a doctor's order for the services and the need for a licensed healthcare professional to provide them.

Eligibility Criteria for Home Health Care Services with Fidelis

To be eligible for home health care services with Fidelis, an individual must meet certain criteria. These criteria may include:

  • Having a doctor's order for the services
  • Being homebound, meaning that leaving the home requires a considerable and taxing effort
  • Requiring skilled nursing care or therapy services on an intermittent basis
  • Having a condition that is expected to improve with treatment

It's important to note that not all Fidelis plans may cover home health care services and eligibility requirements may vary depending on the plan. It's recommended to review the specific plan details or contact Fidelis directly to confirm eligibility.

How to Obtain Home Health Care Services through Fidelis

To obtain home health care services through Fidelis, the following steps should be taken:

  1. Consult with your doctor: The first step is to consult with your doctor to determine if home health care services are necessary and appropriate for your medical condition. Your doctor can also provide you with a referral for a licensed healthcare professional who can provide the necessary services.
  2. Check your plan coverage: It's important to review your Fidelis plan details to confirm that home health care services are covered under your plan. If you're unsure about your plan coverage, contact Fidelis directly for more information.
  3. Contact a licensed healthcare provider: Once you have confirmed that home health care services are covered under your plan, you can contact a licensed healthcare provider who provides these services. The provider will work with you and your doctor to develop a personalized care plan that meets your specific needs.
  4. Schedule an assessment: Before starting any home health care services, an assessment will be conducted by the provider to determine the level of care needed and the frequency of visits required.
  5. Begin receiving services: Once the assessment is completed, you can begin receiving home health care services from the licensed healthcare professional, including skilled nursing care, therapy services, medical social work, and home health aide services as needed.

By following these steps and working closely with your doctor and licensed healthcare provider, you can easily obtain the necessary home health care services through Fidelis.

Limitations of Fidelis' Coverage for Home Health Care Services

While Fidelis does offer coverage for home health care services, it's important to note that there may be limitations to this coverage.

Limitations

  • Doctor's order and licensed healthcare professional: Fidelis requires a doctor's order and the need for a licensed healthcare professional to provide the services.
  • Plan coverage: Not all Fidelis plans may cover home health care services, and eligibility requirements may vary depending on the plan.

Copays and deductibles

Another important factor to consider is any copays or deductibles that may apply to home health care services. Depending on the specific plan and services received, patients may be responsible for paying out-of-pocket costs before insurance coverage kicks in.

It's recommended to review the specific details of your Fidelis plan or contact Fidelis directly to determine any copays or deductibles that may apply.

While Fidelis does offer coverage for home health care services, it's important to understand any limitations or costs associated with this coverage before receiving these services.

By reviewing your plan details and working closely with your doctor and licensed healthcare provider, you can ensure that you receive personalized care that meets your needs while minimizing any out-of-pocket expenses.

Additional Support and Resources for Patients Receiving Home Health Care Services

In addition to covering a variety of home health care services, Fidelis also offers additional support and resources to patients who receive these services. These resources can help patients and their families better manage their medical conditions and improve their overall quality of life.

Caregiver Training

Fidelis offers caregiver training programs to help family members or other caregivers learn how to provide the necessary care for their loved ones at home. This training can include instruction on administering medications, providing wound care, managing medical equipment, and more.

By offering caregiver training programs, Fidelis helps ensure that patients receive high-quality care from knowledgeable and well-prepared caregivers.

Medical Equipment Rental

In some cases, patients may require specialized medical equipment to assist with their care at home. Fidelis offers medical equipment rental programs that allow patients to rent equipment such as hospital beds, wheelchairs, oxygen tanks, and more.

By providing access to this equipment through rental programs, Fidelis helps reduce the financial burden on patients while ensuring that they have the necessary tools to manage their conditions effectively.

Overall, these additional support and resource offerings demonstrate Fidelis' commitment to providing comprehensive care for its members. By going beyond just covering basic health care services, Fidelis helps ensure that its members receive the highest level of care possible.

Comprehensive and Affordable Health Insurance Plans

Free photo front view assortment of medical still life elements

Fidelis Care is a non-profit health insurance company that has been providing comprehensive coverage to New York State residents for over 25 years. The company was founded with the mission of ensuring that all New Yorkers have access to quality, affordable healthcare.

Fidelis offers a wide range of health insurance plans, including Medicaid, Medicare Advantage, Essential Plan, and Qualified Health Plans. Each plan is designed to meet the unique needs of individuals and families at different stages of life.

In addition to covering home health care services, Fidelis also provides coverage for a variety of other medical services. These services may include preventive care, hospitalization, prescription drugs, mental health and substance abuse treatment, and more.

Fidelis is committed to making healthcare accessible and affordable for all New Yorkers. The company offers financial assistance programs to help individuals who may be struggling to pay for their healthcare expenses. These programs include premium assistance, cost-sharing reductions, and more.

To learn more about Fidelis Care and its coverage options, visit their website or contact them directly.

Qualifications and Credentials of Healthcare Professionals Providing Home Health Care Services through Fidelis

Healthcare professionals who provide home health care services through Fidelis are required to meet certain qualifications and credentials. These requirements ensure that patients receive high-quality care from trained professionals.

Registered Nurse (RN)

Registered nurses are licensed healthcare professionals who have completed a nursing program and passed the national licensing exam. RNs are qualified to provide a wide range of medical services, including administering medication, wound care, and managing complex medical conditions.

Licensed Practical Nurse (LPN)

Licensed practical nurses are also licensed healthcare professionals who have completed a nursing program and passed the national licensing exam. LPNs work under the supervision of RNs or physicians and are qualified to provide basic medical care, such as taking vital signs and administering medication.

Physical Therapist (PT)

Physical therapists are licensed healthcare professionals who have completed a physical therapy program and passed the national licensing exam. PTs specialize in helping patients recover from injuries or illnesses by providing exercises and other therapies that improve mobility and reduce pain.

Occupational Therapist (OT)

Occupational therapists are licensed healthcare professionals who have completed an occupational therapy program and passed the national licensing exam. OTs specialize in helping patients improve their ability to perform daily tasks, such as dressing, cooking, and cleaning.

Speech-Language Pathologist (SLP)

Speech-language pathologists are licensed healthcare professionals who have completed a speech-language pathology program and passed the national licensing exam. SLPs specialize in helping patients improve their ability to communicate, swallow, and speak clearly.

In addition to these qualifications, all healthcare professionals providing home health care services through Fidelis must be licensed by the state of New York. This ensures that they meet all state requirements for practicing their profession.

By working with qualified healthcare professionals who meet these requirements, patients can feel confident that they're receiving high-quality care that's tailored to their specific needs.

Conclusion

Fidelis Care is a non-profit health insurance company that offers comprehensive coverage to New York State residents. Their home health care services include skilled nursing care, physical therapy, occupational therapy, speech therapy, medical social work, and home health aide services. Eligibility criteria for Fidelis' home health care services include having a doctor's order for the services, being homebound, requiring skilled nursing care or therapy services on an intermittent basis and having a condition that is expected to improve with treatment.

Patients can obtain these services by consulting with their doctor, checking plan coverage and contacting a licensed healthcare provider. While there may be limitations to Fidelis' coverage for home health care services, they offer additional support and resources such as caregiver training programs and medical equipment rental programs.

Fidelis also provides comprehensive coverage for a wide range of medical services including preventive care, hospitalization, prescription drugs, mental health and substance abuse treatment. They are committed to making healthcare accessible and affordable for all New Yorkers by offering financial assistance programs such as premium assistance and cost-sharing reductions.

Healthcare professionals who provide home health care services through Fidelis must meet certain qualifications and credentials such as being licensed by the state of New York. By working with qualified healthcare professionals who meet these requirements, patients can feel confident that they're receiving high-quality care that's tailored to their specific needs.

Sources

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