Insurance Page

Insurance Benefits

Very often clients are unaware of the nursing benefits available to them, both in the hospital and at the home. The insurance specialist at Tri-Borough Home Care will be happy to check out your major medical, no-fault and workmen’s compensation coverage and handle all aspects of the claim for you.

If you have coverage, Tri-Borough Home Care will accept “assignment of benefits” so that in many cases, you need not pay for nursing service out of your own pocket.

We also accept private pay insurance and third party reimbursement. Your nurse can explain the rules regarding eligibility for payment and reimbursement. If you don’t have insurance and are concerned about cost, please talk to your nurse to determine whether you are eligible for a financial assistance/payment plan.

Understanding Insurance

Tri-Borough Home Care has a team of dedicated reimbursement professionals. This team can provide much-needed assistance to patients with insurance related questions, from benefits verification and claims filing, to billing and reimbursement. In most cases, Tri-Borough Home Care will bill a patient’s insurance company so the patient doesn’t have to pay for therapies up front and then file claims for reimbursement. At present we are providers for the following health maintenance organizations:

We accept the following:

  • Center Light
  • ADAP/ADAP Plus (HIV/AIDS uninsured)
  • Aetna Better Health Inc
  • Aetna – US Health Care
  • CareCentrix/Gentiva
  • CCM = Comprehensive Care Management
  • CIGNA Health Care
  • Elderplan Home Care
  • Elderplan Medicare
  • Elderserve Health, Inc.
  • Emblem Health
  • Fidelis Care New York
  • Guildnet
  • Health First
  • Homefirst Inc.
  • Independence Care System
  • Integra
  • Medicaid (Private Duty Nursing)
  • New York State Insurance Fund (Workers Compensation)
  • No Fault Insurance
  • Private Pay
  • Senior Health Partners
  • Senior Whole Health of New York
  • United Health Care Insurance Co.
  • Veterans Administration
  • Village Senior Service Corp d/b/a Village Care Max
  • Visiting Nurse Managed Care Corporation (VNMCC)
  • Well Care of New of New York

Paying for Home Health Care

Are home health care services covered by health insurance?

Many health insurance carriers have a home health benefit covered under the major medical portion of the policy or prescription benefit. Some choose a home health care company that their members must use in order to be covered for services (this is called a “preferred provider”). If you need home health care services, you should check with your insurance carrier to see if they have a designated home health care company. Other types of insurance do not restrict which home health care company their members use, but may limit the home health benefit in some way (e.g., total number of visits, hours or dollars spent on home health care permitted in a year). Check your subscriber agreement or contact you health plan for the deductible and co-insurance that may apply.

Can people without insurance pay out-of-pocket for services?

Yes. In addition, our office staff will assist patients in identifying alternate payor sources, or refer them to local community agencies for additional assistance.

What services does Medicare cover?

Medicare covers part-time or intermittent skilled nursing, physical therapy, speech-language pathology, occupational therapy, medical social worker and home health aide services in patients’ homes when certain criteria are met. In addition, certain supplies and durable medical equipment are also covered under the home health benefit. When services meet all the Medical coverage criteria, Medicare pays for covered home health services at 100% without deductible or coinsurance with the exception of durable medical equipment for which Medicare pay 80%. A home health agency can explain the Medicare requirements in detail as they apply to your solution.

What services does Medicaid cover?

Medicaid coverage for home health services varies from state to state and program to program. Medicaid generally covers nursing, home health aide and supplies, but may set restrictions on the number of visits and have other coverage requirements. Your case worker can help to explain covered benefits.

Private Pay Home Care Services

At Tri-Borough Home Care, we understand the concerns that you face. Private pay home care services are designed to address those concerns. Our extensive experience in screening, training and supervising health care providers has helped us maintain standards of delivery of service as well as clinical standards of excellence. Our highly trained staff can save you valuable time and money that you would otherwise spend seeking alternative care providers. That means you don’t have to worry about how to find, hire, train and supervise caregivers. We do it for you.

Star Bronx
Star Brooklyn
Star Manhattan
Star Nassau
Star Queens & Rockaway
Star Staten Island
House icon 1414 Utica Avenue
Brooklyn, NY 11203
Phone icon PH:           (718)-282-7619
Fax:          (718)-282-7314
Toll Free: 1-(800)-752-1821
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