The mission statement of Valley Home Care, Inc., which is a part of Valley Health System, is to support the integrated delivery of health and wellness programs to populations within our service area.
We will respond to the changing healthcare needs of our community with flexibility and innovation and will undertake those services where we can maintain the highest standards of practice in a fiscally responsive manner.
How do people pay for home care?
Most patients are enrolled in some kind of insurance program. Your nurse will ask to see your insurance card to confirm that we have the correct information. Covered services may include nurses, home health aides, therapists, nutritionists and social workers. Your nurse, working with your physician, will design a plan of care with you and your family to meet your needs.
Medicare: Valley Home Care, Inc., 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 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
- Non-medical Equipment
- Live-In Caregiver
- 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 Valley 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.
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: Valley Home Care, Inc. accepts 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: New Jersey 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 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. Please contact your insurance company directly if you have any questions about your coverage.
Account inquires should be directed to these Billing Department numbers:
||201-291-6000, ext. 7467
||201-291-6000, ext. 7465 or 7468
|No Insurance/ Credit Card
||201-291-6225, or 6215
What about those who wish to pay for home care services?
Medicare Part B deductible and co-payments are the beneficiary's responsibility. Non-covered services can be paid for privately. Installment plans and credit card payment can be arranged by the Billing Department. If you cannot afford to pay, patients may apply with Valley Home Care for Charity Care based on New Jersey State Department 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.
Skilled professional and support services are provided in your place of residence. The services are provided on a part-time basis under your physician’s orders.
Staff are scheduled to make visits from 8 a.m. – 6 p.m., Monday through Friday. Weekend, evening and holiday visits are scheduled and made as needed. The office and switchboard are open from 8 a.m. – 5 p.m. weekdays. Calls made to the agency after 5 p.m. or on a weekend or holiday are picked up by the answering service who will contact the nurse on-call to respond to you or take a message when appropriate.