Does Fidelis Care Cover Rehab Treatment?

Fidelis Care is a health insurance provider that offers coverage to individuals and families in New York State. If you or a loved one is struggling with addiction, you may be wondering if Fidelis Care covers rehab treatment. The short answer is yes, Fidelis Care does cover rehab treatment, but the specifics of your coverage will depend on your specific plan.

Fidelis Care Coverage for Rehab Treatment

Fidelis Care covers both inpatient and outpatient rehab treatment for substance abuse and mental health disorders. This means that if you or a loved one needs help with addiction or mental health issues, Fidelis Care can help cover the costs of treatment.

Some of the types of rehab treatment that Fidelis Care covers include:

Detoxification
Residential treatment
Partial hospitalization
Intensive outpatient treatment
Outpatient treatment

Fidelis Care Plans that Cover Rehab Treatment

Fidelis Care offers a variety of plans, and the specifics of your coverage will depend on the plan you have. However, all Fidelis Care plans are required by law to provide coverage for mental health and substance abuse treatment.

If you have a Medicaid plan through Fidelis Care, you will have coverage for rehab treatment. If you have a Qualified Health Plan (QHP), you will also have coverage for rehab treatment.

The specific details of your coverage will depend on your plan, so it's important to review your policy documents or contact Fidelis Care directly to determine your coverage options.

How to Get Rehab Treatment with Fidelis Care?

If you or a loved one needs rehab treatment and you have Fidelis Care, there are a few steps you can take to get the help you need.

Contact Fidelis Care: The first step is to contact Fidelis Care to determine your coverage options. You can call Fidelis Care directly or visit their website to learn more.
Find a rehab center: Once you know what your coverage options are, you can start looking for a rehab center that meets your needs. Fidelis Care has a network of providers that offer rehab treatment, so you may want to start your search there.
Get a referral: Depending on your plan, you may need a referral from your primary care physician in order to receive rehab treatment. Make sure you understand your plan's requirements before you start treatment.

The Process of Filing a Claim for Rehab Treatment with Fidelis Care

If you're planning to undergo rehab treatment covered by Fidelis Care, it's important to understand the process of filing a claim. Here are the steps you need to follow:

Contact your provider: Before undergoing any rehab treatment, contact your provider to ensure that the treatment is covered under your plan.
Get pre-authorization: Depending on your plan, you may need pre-authorization from Fidelis Care before starting treatment. This means that you will need to provide information about your diagnosis and treatment plan before receiving approval.
Start treatment: Once you have received pre-authorization, you can start your rehab treatment.
Pay for services: You may be required to pay for certain services out-of-pocket if they are not covered under your plan. Make sure to keep all receipts and invoices related to your treatment.
Submit a claim: After completing your rehab treatment, submit a claim to Fidelis Care for reimbursement of any out-of-pocket expenses. You will need to provide documentation such as receipts and invoices along with the claim.

It's important to note that the claims process may differ depending on your specific plan and the type of rehab treatment you receive. Be sure to review your policy documents or contact Fidelis Care directly for more information on how to file a claim for rehab treatment.

Duration of Rehab Treatment Covered by Fidelis Care

The duration of rehab treatment covered by Fidelis Care may vary depending on your specific plan and the type of treatment you receive. Generally, Fidelis Care covers a certain number of days or sessions for each type of rehab treatment.

For example, inpatient treatment may be covered for a certain number of days, while outpatient treatment may be covered for a certain number of sessions. Partial hospitalization programs and intensive outpatient programs may also have limits on the number of days or sessions that are covered.

If you need more days or sessions than what is covered under your plan, you may need to pay for additional services out-of-pocket.

However, some plans offer exceptions for extenuating circumstances, so it's important to review your policy documents or contact Fidelis Care directly for more information on coverage limits.

If you're unsure about how many days or sessions are covered under your plan, you can contact Fidelis Care to learn more. Additionally, your rehab center should be able to provide information about coverage limits and work with you to develop a treatment plan that fits within your coverage.

Verifying Coverage Before Starting Rehab Treatment

It's important to verify your coverage before starting rehab treatment with Fidelis Care. While Fidelis Care covers rehab treatment for substance abuse and mental health disorders, the specific details of your coverage will depend on your plan.

This means that some types of treatment or services may not be covered, or there may be limits on the number of days or sessions that are covered.

By verifying your coverage before starting treatment, you can avoid unexpected costs and ensure that you receive the care you need within your coverage options. To verify your coverage, you can contact Fidelis Care directly or review your policy documents.

In some cases, you may need pre-authorization from Fidelis Care before starting treatment. This means that you will need to provide information about your diagnosis and treatment plan before receiving approval.

It's important to understand your plan's requirements for pre-authorization and ensure that you have received approval before starting treatment.

Additionally, it's important to understand any out-of-pocket costs associated with rehab treatment. Some plans require co-payments or deductibles for certain services, which means that you will be responsible for a portion of the cost of treatment.

By taking the time to verify your coverage and understand any out-of-pocket costs associated with rehab treatment, you can make informed decisions about your care and avoid unexpected expenses.

Cost-Sharing Requirements for Rehab Treatment with Fidelis Care

While Fidelis Care covers rehab treatment for substance abuse and mental health disorders, it's important to understand the cost-sharing requirements under different Fidelis Care plans. Depending on your plan, you may be responsible for certain out-of-pocket expenses associated with rehab treatment.

Here are some of the cost-sharing requirements you should be aware of:

Co-payments

Some Fidelis Care plans require co-payments for certain services related to rehab treatment. A co-payment is a fixed amount that you pay out-of-pocket each time you receive a service. For example, if your plan requires a $20 co-payment for outpatient visits, you will need to pay $20 each time you visit an outpatient rehab center.

Deductibles

A deductible is the amount of money you need to pay out-of-pocket before your insurance coverage kicks in. For example, if your plan has a $1,000 deductible and you receive rehab treatment that costs $2,000, you will need to pay the first $1,000 out-of-pocket before Fidelis Care starts covering the remaining costs.

Coinsurance

Coinsurance is a percentage of the total cost of a service that you are responsible for paying out-of-pocket. For example, if your plan requires 20% coinsurance for inpatient rehab treatment that costs $10,000, you will need to pay $2,000 (20% of $10,000) while Fidelis Care covers the remaining $8,000.

It's important to review your policy documents or contact Fidelis Care directly to determine what cost-sharing requirements apply to your specific plan. By understanding these requirements ahead of time, you can make informed decisions about your care and budget accordingly.

How to Appeal a Denial of Coverage for Rehab Treatment by Fidelis Care?

If Fidelis Care denies coverage for your rehab treatment, you have the right to appeal their decision. Here are the steps you can take to appeal a denial of coverage:

Understand why your claim was denied: Before starting an appeal, it's important to understand why your claim was denied. Review your policy documents or contact Fidelis Care directly to determine the reason for the denial.
Gather supporting documentation: Once you understand why your claim was denied, gather any supporting documentation that may help support your appeal. This may include medical records, treatment plans, and letters from healthcare providers.
Submit an appeal: To submit an appeal, you will need to follow the appeals process outlined by Fidelis Care. This typically involves submitting a written request for an internal review of the denial.
Request an external review: If your internal appeal is denied, you have the right to request an external review by an independent organization.
Work with a patient advocate: Consider working with a patient advocate who can help guide you through the appeals process and provide support along the way.

The appeals process may differ depending on your specific plan and state regulations. Be sure to review your policy documents or contact Fidelis Care directly for more information on how to appeal a denial of coverage for rehab treatment.

By appealing a denial of coverage, you can fight for access to care and ensure that you receive the treatment you need within your coverage options.

Additional Resources for Members Seeking Support

In addition to covering rehab treatment for substance abuse and mental health disorders, Fidelis Care also offers additional resources for members seeking support.

One resource available to Fidelis Care members is their Behavioral Health Services department. This department provides support for individuals with mental health or substance abuse issues, including crisis intervention, counseling, and case management services.

Fidelis Care also offers a 24/7 Nurse Advice Line that members can call to speak with a registered nurse about their concerns. This service can be helpful for individuals who have questions about their symptoms or need guidance on where to seek treatment.

Additionally, Fidelis Care has an online portal that allows members to search for providers in their network who specialize in mental health and substance abuse treatment. This can be a useful tool for individuals who are looking for specific types of care or need help finding a provider in their area.

By offering these additional resources, Fidelis Care aims to provide comprehensive support for individuals with mental health or substance abuse issues. If you're a member of Fidelis Care and need help, don't hesitate to reach out to these resources for support.

FAQs

Here are some frequently asked questions about Fidelis Care's coverage for rehab treatment:

What types of rehab treatment does Fidelis Care cover?

Fidelis Care covers a range of rehab treatments for mental health and substance abuse disorders, including inpatient treatment, outpatient treatment, partial hospitalization programs, and intensive outpatient programs. However, the specific coverage details will depend on your plan.

How do I find out if my plan covers rehab treatment?

The best way to determine your coverage options is to contact Fidelis Care directly. You can call their customer service line or visit their website to learn more about your plan's benefits and limitations.

Do I need a referral from my primary care physician to receive rehab treatment with Fidelis Care?

Depending on your plan, you may need a referral from your primary care physician in order to receive rehab treatment. Make sure you understand your plan's requirements before starting treatment.

What documentation do I need to submit a claim for reimbursement of out-of-pocket expenses related to rehab treatment?

To submit a claim for reimbursement of out-of-pocket expenses related to rehab treatment, you will need to provide documentation such as receipts and invoices. Be sure to keep track of all expenses related to your treatment so that you can submit an accurate claim.

How long does it take for a claim for reimbursement of out-of-pocket expenses related to rehab treatment to be processed?

The processing time for claims can vary depending on the complexity of the claim and the volume of claims being processed. However, Fidelis Care aims to process claims as quickly as possible so that members receive reimbursement in a timely manner.

By understanding these frequently asked questions about Fidelis Care's coverage for rehab treatment, you can make informed decisions about your care and ensure that you receive the support you need within your coverage options.

Conclusion

If you or a loved one is struggling with addiction or mental health issues, Fidelis Care can help cover the costs of rehab treatment. While the specifics of your coverage will depend on your specific plan, all Fidelis Care plans are required to provide coverage for mental health and substance abuse treatment. Contact Fidelis Care to learn more about your coverage options and take the first step towards getting the help you need.