The following billing policy applies to Non-Medical Home Care,
Home Health and In-Home Palliative Care Payment Policy.
The following billing policies apply to Good Hands in home care contracted non medical home care clients and home health care clients and providers including providers who render non medical in home care services in the home which is a part of Favor Network.
These policies are to support the integrated delivery of non medical home care , home health care and wellness programs to populations within our service area in the most efficient and affordable way.
How do people pay for home care?
Most patients are enrolled in some kind of Long Term Care (LTC) insurance program.
Your Good Hands in home care Representative will ask to see your insurance card to confirm that we have the correct information.
Covered services may include CNA's, home health aides, caregivers, nurses, home health aides, therapists, nutritionists and social workers.
Your Good Hands in Home Care Representative, working with your LTC insurance, family and primary care physician, will design a plan of care with you and your family to meet your needs.
Do you accept private pay clients?
Do you accept deposit for care services?
We accept a deposit of care services from all private pay and LTC customers.
The deposit is determined by the anticipated cost of care services for 1 month.
We accept the deposit against the last month of care and use it for the cost of the last month of care once a proper, written 30 days notice has be given in accordance with terms of the service agreement.
How often do you bill for services?
We bill for services depending on the service care plan and the level of care agreed upon. We will conveniently bill on the 15th and the last day of the month. Or, Once monthly at the beginning of the month One month in advance of services rendered. These policies are subject to change at the discretion of Agape Love Care Network,Inc. it's managing directors or officers.
Medicare: Good Hands in Home Care, accepts assignment of benefits from Medicare A pending any regulatory changes.
This means your home care services are covered if assessed to meet Medicare criteria.
Your representative or nurse will let you know in advance when you no longer meet the criteria and discharge is planned.
You may receive a letter from the Medicare Benefits Administrator/United Government Services regarding Utilization of Services.
This is not a bill. It is to keep you informed of services we have billed for.
What is not covered by Medicare?
Unskilled care/Custodial Care
Private Duty Requests
What are the basic Medicare qualifying criteria?
You are under doctor’s orders for care. You are confined to home for illness/injury. You need skilled care. You required “part-time” care.
Your care meets Medicare’s description of “Reasonable and Necessary.”
If you qualify for Medicare home care services:
Medicare regulations state that the Home Health Agency is responsible for payment of outpatient rehabilitation therapy and certain medical supplies and so must be billed with your Home Care Services.
You must tell your nurse or therapist if you are already receiving or will be starting outpatient rehabilitation therapy services while you are on service with Good Hands in Home Care.
You must tell your nurse or therapist if you are using any medical supplies (e.g., ostomy supplies).
You must tell your nurse or therapist if your services are related to a Motor Vehicle Accident or Liability case.
Medicare HMO: Your insurance company will be notified by phone, and authorization will be obtained for all services. Depending on the agency’s contracts with the HMO, claims are submitted and reviewed by your insurance company. Payment is always subject to provisions of your policy.
You must tell your nurse or therapist if there is a change in your insurance and you have recently enrolled in a Medicare HMO.
Medicaid: Good Hands In Home Care may accept assignment of benefits from Medicaid. This means your home care services are covered if assessed to fit Medicaid criteria by the admitting professional.
Medicaid HMO: California Medicaid contract HMO’s require pre-authorization. Not all HMOs are contracted with this agency. Payment will be based on authorization, contracting and provisions of the Medicaid HMO policy.
You must tell your representative, nurse or therapist if your insurance recently changed or switched to a Medicaid HMO.
HMOs, PPOs and private insurance plans:
Your insurance company will be notified by phone for authorization of services. Claims are reviewed by your insurance company and payment is subject to provisions of your policy.
We will make every attempt to resolve any billing or claim issue with your insurance company. However, we want to remind you that the patient is ultimately responsible for balances not reimbursed by the insurance company, i.e., deductibles, coinsurance/copay, out of network penalties, out of pocket expenses, policy limits and denials of coverage.
There are no guarantees of payment although pre-authorization may have been obtained. You will be informed of any additional costs to you that are not covered. You will be required to keep a valid credit card or checking account on file as a valid form of payment to secure services.
Please contact your insurance company directly if you have any questions about your coverage.
Medicare or Medicaid account inquires should be directed to these Billing Department numbers:
I have my own insurance so why do I have to pay for care services upfront?
The overall cost of care, deductibles, and co-payments are the clients and or clients representative's responsibility. We will provide you copies of all paid invoices and receipts so that you may submit them to your insurance company for reimbursement.
As a courtesy, We will submit all paid invoices to your insurance on your behalf at your request as well.
Non-covered services can be paid for privately. These costs are paid for in advance based Installment plans and credit card payment can be arranged by the Billing Department.
If you cannot afford to pay, patients may apply with In Home Support Services (IHSS) based on California Department Public of Health guidelines.
How long will I receive services?
The amount of services and length of time you receive services will depend upon what your physician has ordered and your insurance authorization.
We will notify you and your physician if your insurance will not cover all of the services ordered and will discuss other care and/or payment options.
Good Hands In Home Care Representatives and Staff are scheduled to make visits regarding billing from 9:00 a.m. – 6:00 p.m., Monday through Friday.
Weekend, evening and holiday visits are scheduled and made as needed. The office and switchboard are open from 9:00 a.m. – 6:00 p.m. PST on weekdays.
Calls made to the agency after 5 p.m. or on a weekend or holiday are picked up by an administrator on duty or answering service who will contact the representative for your account to respond to you or take a message when appropriate.
HOME CARE YOU CAN TRUST!
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