Riverstone Healthcare-PAYMENT OPTIONS
Riverstone Healthcare--Billing Information



Payment Options & Insurances Information:


Riverstone Healthcare In-home services offer flexible payment options, including the acceptance of most insurances, long-term care insurance, private pay, Medicare*, Medicaid*, and Workers’ Compensation to ensure that you or your loved one is able to get the best care available.

* pending contracting.

Our online payment is available for your convenience **. If you need assistance for further information, please feel free to contact our office.

** coming soon!

Insurances

Most commercial and private health insurance policies typically cover some home healthcare services for acute medical needs or treatment of chronic conditions in addition to comprehensive hospice services. However, the benefits offered for long-term care services often vary from plan to plan. While insurers will generally pay for in-home medical services with a cost-sharing provision, personal care services are not always covered, which can make it necessary to purchase Medigap insurance, long-term care insurance policies, or pay out-of-pocket for additional homecare coverage.


Long-Term Care Insurance

What is Long-Term Care (LTC) Insurance?

Long-Term Care Insurance pays for the treatment of ailing individuals who need medical care over an extended period. It can help you cover the cost of in-home assistance, adult day care, assisted living services, or nursing home care.

Long-Term Care Insurance has existed for almost 40 years. When Medicare was first established, many insurance companies began marketing Long-Term Care Insurance as a supplement that would cover services that Medicare did not. In the beginning, Long-Term Care Insurance policies were similar to a basic Medicare supplement policy, but today, its coverage has grown to include almost any condition and can stand apart from state sponsored programs. Long-Term Care Insurance typically covers a broad range of services including care for patients in hospitals and medical facilities, long-term care facilities, assisted living facilities, and private residences. It can protect your family's financial future as well as your investments and savings. Like any other insurance policy, a Long-Term Care policy requires monthly premiums until you need to use it.

Long-Term Care Insurance helps to cover:

• Daily activities of living such as bathing, eating, and dressing

• Skilled nursing care

• Rehabilitation, either in a nursing facility or at home

• Cognitive impairment care, such as Alzheimer’s care


Who should consider Long-Term Care Insurance?

According to the U.S. Department of Health and Human Services (HHS), if you live beyond age 65, there is about a 70 percent chance that you will need a form of long-term medical care at some point in your life. Health is also an important consideration. The state of you or your loved one’s health is a determining factor in the ability to secure Long-Term Care protection. This sometimes poses a problem as people don't often consider Long-Term Care insurance until an unfortunate event has affected their health or the health of a loved one.

Long-Term Care may be required by anyone, not just seniors. Care is usually required as a result of the effects of aging, either because a person has become physically unable to carry out everyday activities or because they experience cognitive impairment, such as Alzheimer's disease. Other times, long-term care may be needed because of a chronic condition or while recuperating from an accident or serious illness.

Medicare

Medicare can be confusing and difficult to understand, particularly if you have recently become responsible for the care of a parent, grandparent, or loved one. At Riverstone Healthcare Services, we understand that when the time comes for you or your loved one to seek professional care services, navigating the Medicare system can be overwhelming. We are here to help. Riverstone specializes in healthcare for individuals in hospitals and medical facilities, long-term care facilities, assisted living facilities, and private residences. Our clients have peace of mind knowing that they are working with an industry expert dedicated to their comfort and satisfaction.

What is Medicare?

Medicare is health insurance offered to eligible individuals by the federal government through The Center for Medicare & Medicaid Services. It offers coverage for necessary inpatient and outpatient medical care, certain types of Physician-ordered durable medical equipment, and short-term rehabilitation or skilled nursing care following a qualifying hospital stay. While Medicare does help pay for healthcare, it does not cover all medical expenses.

Who is eligible for Medicare?

• Individuals 65 and older, receiving Social Security or Railroad Retirement Board benefits

• Individuals younger than 65 who are permanently disabled or who have been diagnosed with end-stage renal disease

What Medicare options are available?

Medicare has four parts:

Medicare Part A is the original Medicare insurance coverage that helps pay for hospital bills. It is the only part that is automatically covered when an individual signs up for Medicare. Most people will not have to pay a monthly premium for Part A because either they or their spouse paid Medicare taxes while they were employed. Part A covers costs when in the hospital, such as:

• Hospital rooms

• Meals

• Nursing services

• Hospice care and home healthcare


Medicare Part B is a supplemental insurance option for people who qualify for Medicare. Its purpose is to provide coverage for healthcare not covered under Part A, such as Physician services outside the hospital setting and other medical services not covered under Part A. Individuals must sign up for Medicare Part B and pay a monthly premium and annual deductible, which are deducted from their Social Security check. Additional services covered by Part B include:

• Physician visits

• Laboratory tests and X-rays

• Physical therapy or rehabilitation services

• Ambulance service

• Some home healthcare

• Medical equipment and supplies when medically necessary


Medicare Part C or Medicare Advantage Plans are private health plans that are Medicare approved to offer healthcare to eligible people. They provide all of Medicare Part A and Part B coverage and must cover medically-necessary services. These plans generally offer additional benefits and many include Part D drug coverage. Similar to Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), Medicare Advantage Plans often have networks, meaning it may be necessary to see the plan's Physicians and go to certain hospitals to receive care. These plans can save money since the out-of-pocket costs in them are typically lower than with Medicare alone; however, costs will vary by the services used and the type of policy purchased.

Medicare Part D is prescription drug coverage. Your loved one must be enrolled in Medicare before he/she can apply for Part D coverage. There are many plans and pricing options to choose from under Part D, so it is important to carefully review your loved one’s prescription drug needs when selecting a Part D plan. Part D plans, similar to the Medicare Advantage Plans, are issued by private insurance companies authorized to sell their plans in specific areas.

Medigap Plans, also known as Medicare supplemental plans, work with the original Medicare program to help cover some of the out-of-pocket costs like annual deductibles, co-pays, and co-insurances. There are twelve standardized Medigap plans available (A through L), and the Medicare program determines the type of coverage for each plan. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Despite this, there can be large differences in the charges of various plans, so it always pays to research all of the options before choosing a Medigap Plan.

All Riverstone offices are Medicare & Medicaid certified. Riverstone’s Medicare certified offices will work with patients and their families to help gain a better understanding of Medicare eligibility requirements, the different options available, as well as the services that should be covered by Medicare. Medicare does not cover all home health medical expenses. Please contact your local Riverstone office to determine whether or not Medicare is an accepted coverage option for your healthcare needs in your area.

Medicaid

At Riverstone Healthcare Services, we understand that seeking professional care for you or a loved one can be difficult, and navigating the Medicaid system can be overwhelming. We are here to help. Riverstone has earned a reputation for our dedication to customer service and for the quality of our healthcare professionals. We’re committed to making healthcare more responsive and effective every day.

All of Riverstone’s offices are licensed, as required, and accredited by the Accreditation Commission for Healthcare (ACHC). In addition, many Riverstone offices are also Medicare & Medicaid certified. Riverstone’s Medicaid certified offices will work with patients and their families to help gain a better understanding of Medicaid eligibility requirements, the different options available, as well as the services that should be covered by Medicaid.

What is Medicaid?

Medicaid is a state administered health program for eligible individuals and families with low incomes and resources that are jointly funded by both the state and federal government through The Center for Medicare & Medicaid Services. It offers coverage for necessary inpatient and outpatient medical care, nursing facility services for children under age 21, rehabilitation and physical therapy services, and home and community-based care to certain persons with chronic conditions.

Who is Eligible for Medicaid?

• Low-income individuals and families who fit into select eligibility groups as recognized by federal and state law, including:

• Pregnant Women

• Children and Teenagers

• Individuals 65 and older

• Individuals who may be blind and/or disabled

• Individuals leaving welfare

• Families with children under the age of 18 as well as limited income and resources

• Individuals/families with high medical bills that cannot be paid (must also meet other Medicaid eligibility)


What is Covered?

• Physician services

• Laboratory and x-ray services

• Inpatient hospital services

• Outpatient hospital services

• Early and periodic screen diagnostic, and treatment (EPSDT) services for individuals under 21

• Family planning

• Rural and federally-qualified health center (FQHC) services

• Nurse midwife services

• Nursing facility (NF) services for individuals 21 or over

• Prescription drugs

• Clinic services

• Dental services and dentures

• Physical therapy and rehab services

• Prosthetic devices, eyeglasses

• Primary care case management

• Intermediate care services facilitated for the mentally retarded (ICF/MR)

• Inpatient psychiatric care for individuals under 21

• Home healthcare services

• Personal care services

• Hospice services


Workers' Compensation

If you or a loved one becomes injured or sick as a result of work, your employer is required by law to pay for workers' compensation benefits. These benefits can provide compensation for mental injuries, traumatic physical injuries, as well as injuries that are the result of cumulative or repetitive trauma.

Injuries can occur on the job, no matter how safe your workplace is. Should you need assistance or care as result of an occupational injury or illness, Riverstone Healthcare Services can help. We will work with insurers, state programs, claims managers, Physicians, and Case Managers to provide top quality care that promotes a safe return to work. Our central focus is providing the finest and most appropriate in-home nursing and therapy for both patients and their families. Riverstone’s team of skilled medical professionals is available to assist those who have been injured on the job with the care, education, and support services needed in the comfort of their home.

Should you need assistance with a referral for a patient who was injured on the job, please contact your local Riverstone office for more information.


Self Pay

Insurance plans often have restrictions and limits. If your insurance does not cover the services you need, or discontinues payment for services sooner than you are ready for or expect, you are generally left to pay the difference ‘out-of-pocket.’

Service Fees

The home care needs of seniors, adults, pediatric patient and their families differ widely. We have crafted a price structure that gives the best value at each acuity level. Please call us to discuss which Plan of Care is right for you.


One Time Set-Up Fee of $35 (non-refundable)

Two Week Deposit (Applied to Final Bill)

Hourly Rates

$18-$38/Hour Based on the time (i.e. day-time, night-time or holidays)/length of hours

**Special Live-in Shifts

Live-in Shift minimal 10 hours.

10-12 Hour Live-in shift: 10% off

24 Hour/Live-In Care: not available

Couples Care: 20% off (applies if the 2nd person is receiving individual assistance)



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