Does Fidelis cover MRI?

Imaging (CT/PET scans, MRIs) $0 Not covered Prior authorization is required for certain blood work and diagnostic imaging except x-ray. Facility fee (e.g., ambulatory surgery center) $0 Not covered Prior authorization is required. Physician/surgeon fees $0 Not covered Prior authorization required.

What is Fidelis Care timely filing limit?

IMPORTANT – Claims must be submitted within 90 (ninety) days from the date of service.

Does Fidelis Care have out of network benefits?

Fidelis Care does not cover services by out-of-network providers, EXCEPT: For emergency services. When a request for prior authorization to see an out-of-network provider is approved.

Does Fidelis do peer to peer?

The phone number to initiate a peer-to-peer is 1-888-642- 7649. These discussions provide an opportunity to discuss the case and collaborate on the appropriate services for the patient based on the clinical information provided.

How can I check my Fidelis eligibility?

Beginning August 15, 2022, all Fidelis Care providers inquiring about a patient’s eligibility and benefits will need to use either the Patient Search tool on Fidelis Care’s Provider Portal, Provider Access Online, or the Automated Eligibility system on our Interactive Voice Response (IVR) at 1-888-FIDELIS (1-888-343- …

Is Fidelis Care New York Medicaid?

Fidelis Care, a leading health insurer that serves all of New York State, offers free or low-cost comprehensive health coverage, including Medicaid Managed Care, Medicare Advantage, Child Health Plus, and plans available through NY State of Health, The Official Health Plan Marketplace.

Is Fidelis Care Catholic?

History. Fidelis Care was formed in 1993 as the NYC Catholic Health Plan Inc. by the Catholic Medical Center of Brooklyn and Queens, Inc. and the Diocese of Brooklyn to serve the poor and medically underserved.

Does Fidelis have copays?

All Fidelis Care Qualified Health Plans carry some combination of cost sharing between you and Fidelis Care. Some examples of cost-sharing include deductibles, coinsurance, and/or copays.

Does Fidelis cover vasectomies?

Fidelis Care also covers vasectomies subject to Copayments, Deductibles or Coinsurance. Fidelis Care does not cover services related to the reversal of elective sterilizations. Fidelis Care covers medically necessary abortions and elective abortions allowing for one (1) procedure per Member, per Plan Year.

What is the income limit for NY state of health?

Meet income eligibility requirements. (Examples: single adults earning up to $25,520; adults in family of four earning up to $52,400)

Does NY Medicaid cover chiropractic?

The New York State Medicaid Program will only reimburse an enrolled chiropractor for deductibles or coinsurance, as appropriate, when Medicare approves the procedure. Covered chiropractic services are limited to those services approved by Medicare.

Does Fidelis cover walkers?

Covered items include, but are not limited to: wheelchairs, crutches, hospital bed, IV infusion pump, oxygen equipment, nebulizer, and walker. We cover all medically necessary durable medical equipment covered by Original Medicare.

Does NYS Medicaid cover out of state?

Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can’t just transfer coverage from one state to another, nor can you use your coverage when you’re temporarily visiting another state, unless you need emergency health care.

What is the Medicaid income limit for 2022 in NY?

In 2022, the medically needy income limit is $934 / month for a single applicant and $1,367 / month for a couple. The “spend down” amount is the difference between one’s monthly income and the medically needy income limit.

What is the highest income to qualify for Medicaid 2022?

Federal Poverty Level thresholds to qualify for Medicaid The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.

How much money can you have in the bank to qualify for Medicaid in NY?

For example, a single person can have up to $15,750 in resources and still qualify for Medicaid. A family of two can have up to $23,100. For non-disabled individuals under 65 who don’t receive nursing home care, there is no limit to the amount of assets they can own; Medicaid simply looks at their income.

Is a bronze HealthCare plan worth it?

Bronze plans usually have the lowest monthly premiums but the highest costs when you get care. They can be a good choice if you usually use few medical services and mostly want protection from very high costs if you get seriously sick or injured. Note: Bronze plan deductibles can be very high.

Why health insurance is so expensive?

The price of medical care is the single biggest factor behind U.S. healthcare costs, accounting for 90% of spending. These expenditures reflect the cost of caring for those with chronic or long-term medical conditions, an aging population and the increased cost of new medicines, procedures and technologies.

What is a bronze plan?

A bronze plan is a type of health insurance available on the Affordable Care Act (ACA) marketplace. This plan category describes individual health insurance plans with the least expensive premiums and the highest copay and coinsurance amounts. Additionally, bronze health plans often have higher deductibles.

Is Medicaid a insurance?

1. Medicaid is the nation’s public health insurance program for people with low income. Medicaid is the nation’s public health insurance program for people with low income. The Medicaid program covers 1 in 5 Americans, including many with complex and costly needs for care.

Does Fidelis have an app?

You can get started by downloading the app for your plan from the App Store (iPhone) or Play Store (Android). Babylon and Teladoc visits are covered at no cost to you!

How do I make a payment to Fidelis?

Log in to your Member Portal account at to set up AutoPay and ensure your payments are always made on time. Setting it up is easy: After logging in to the Member Portal, click the “Make a Payment” button. Select the name of your plan.

Is Fidelis Care Medicare or Medicaid?

Fidelis Care is contracted with Medicare for HMO, HMO D-SNP, and HMO-POS plans, and with the state Medicaid program. Enrollment in Fidelis Care depends on contract renewal.

Who bought Fidelis Care?

Centene has completed its $3.75 billion acquisition of nonprofit insurer Fidelis Care, giving it a leading managed care market share in New York.

How do I file a claim with Fidelis?

Claims can also be submitted through clearinghouse Ability, or another clearinghouse. Fidelis Care offers free online claims submission through Ability’s claims portal. To learn more about Ability, call 1-888-499-5465 or visit

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