Can I request a home health aide who speaks my language?
Yes, Elderplan has an extensive network of providers. Our Member Services will make every effort to identify a personal care worker that can speak your language.
Can I obtain interpreter services?
Yes, HomeFirst employees speak multiple languages. We are able to accommodate members with Language Line telephone interpreter services. HomeFirst has member materials written in the most prevalent languages of our enrollees. These languages include English, Russian, Chinese and Spanish. If interpretation is required, please feel free to call Member Services at 718-759-4510 or toll free at 877-771-1119 and request to speak to an interpreter or ask for written materials in your language. For TTY/TDD, call 711.
How do I reschedule, cancel or request changes to my home care services?
If you need to adjust your home care schedule please, contact our HomeFirst Member Services department at 718-759-4510 or toll free at 877-771-1119, Monday through Friday from 8:30 a.m. to 5:00 p.m. For TTY/TDD, call 711. Qualified clinical personnel will determine if a service is medically necessary and appropriate based on a comprehensive assessment of your current condition. We will make a decision about your request no later than 14 days after we receive your request.
If you are in the hospital, be sure to ask your physician or hospital discharge planner to contact HomeFirst. HomeFirst will work with you, your physician and hospital discharge planner to arrange for your care upon discharge from the hospital.
Does HomeFirst provide transportation to appointments?
Yes, routine medical transportation is a benefit offered to HomeFirst’s members. Call ModivCare for your non-emergent transportation needs at 1-877-779-8611 from 8:00 a.m.-5:00 p.m., Monday through Friday, or TTY1-866-288-3133 for the hearing impaired. There is no cost for this service and no restrictions on the number of rides available to you as long as they are to and from medical appointments. Please, call ModivCare at 1-877-779-8612 if your trip is late or you need to cancel your trip.
To ensure timely pickup at your address, please call at least 3 days in advance but no more than 30 days before your appointment to make a reservation. Please call immediately and let ModivCare know of any change in your schedule at least one hour before your scheduled pick up time. ModivCare will provide car, van, taxi, wheelchair vehicle, mileage and mass transit reimbursement. If you have a medical emergency, always call 911 right away.
How do I make appointment for vision, dental and hearing?
For vision benefits inquiries, please call VSP at 1-844-257-2306 Monday – Friday from 11:00 a.m. to 8:00 p.m., EST. The toll-free T.T.Y. number for the vision benefits is 711. For dental benefit inquiries, please call HealthPlex at 1-888-468-5175 Monday – Friday from 9:00 a.m. – 5:00 p.m.,EST. The toll-free T.T.Y. number for dental benefits is 711.
Who is involved in my Care Management Team?
Within the first 30 days, members will receive a Welcome Letter from HomeFirst which provides contact information for your Care Management Team. Your Care Management Team is comprised of an RN or SW Care Manager, Care Coordinator, and a Registered Nurse or Social Work Assessor with expertise in caring for individuals with chronic medical needs. Your Care Management Team will work cooperatively with your physician and other health care professionals to ensure you receive the services you need. An on-call nurse is available 24 hours a day, 7 days per week to answer your questions.
Your Registered Nurse Assessor will complete an assessment at least twice a year and identify any changes or needs you may have. Members may be assessed more frequently if there are requests for additional services, changes in personal care worker service hours, or after a hospitalization.
There are services I require that are not included in HomeFirst’s benefit package. How do I receive these services?
Medicare or Medicaid Fee For Service will continue to cover your doctor, specialists, hospital care and drugs. Your Care Management Team will ensure you receive medically necessary services by arranging and coordinating what you need, even if these services are not covered by HomeFirst. If you need help accessing services, please contact Member Services from 8:00a.m. – 5:00p.m. at 718-759-4510 or toll-free at 877-771-1119. For TTY/TDD, call 711 .
I’ve just relocated. Can you please tell me what providers are in my area and how I can update my mailing address to HomeFirst?
How do I change my provider?
What if my preferred provider is not listed in the HomeFirst directory?
Services covered by HomeFirst such as personal care, dental and non emergent transportation must be obtained from Homefirst participating providers. However, you may obtain a referral to a health care provider outside the network in the event HomeFirst does not have a provider with appropriate training or experience to meet your needs.
You can continue using the provider of your choice if you are receiving a covered service that is a Medicare benefit. HomeFirst recommends that you use a network provider so that you will not have to change providers if Medicare coverage limits are met. HomeFirst also has the ability to monitor the services of network providers and hold them accountable to our professional standards. HomeFirst is unable to monitor the services of providers that are not in the network.
I’m traveling outside of my current service area and will require home care services. Can HomeFirst help me arrange services while I’m away from home?
If you are planning to visit friends or family who live outside of our service area, HomeFirst requests that you inform your Care Management Team as soon as possible. We will help you arrange for medically necessary care that you need while you are away. You can contact Member Services at 718-759-4510 or toll free at 877-771-1119, Monday through Friday, 8:00am to 5:00pm. For TTY/TDD, call 711. If you are planning to leave the service area for more than (60) sixty consecutive days, it will be difficult for HomeFirst to properly monitor your health needs. When this happens HomeFirst must initiate disenrollment.
What if I have a problem with the treatment I have received?
If you have a problem with the care or treatment you receive from our staff or providers, call Member Services at 718-759-4510 or write to Member Services. You can also address your treatment by writing HomeFirst at the following address:
6323 Seventh Avenue, 3rd Floor
Brooklyn, NY 11220
Attn: Member Services
What if I request a service from HomeFirst and it is denied?
When HomeFirst denies or limits services requested by you or your provider; denies a request for a referral; decides that a requested service is not a covered benefit; restricts, reduces, suspends or terminates services that we already authorized; denies payment for services; doesn’t provide timely services; or doesn’t make complaint or appeal determinations within the required timeframes, those are considered plan “actions” and are subject to appeal.
If we decide to deny, or limit or terminate services you requested or decide not to pay for all or part of a covered service, we will send you a notice when we make our decision. If we are proposing to restrict, reduce, suspend or terminate a service that is authorized, our letter will be sent at least 10 days before we intend to change the service.
If you do not agree with an action that we have taken, you may appeal. When you file an appeal, it means that we must look again at the reason for our action to decide if we were correct. You can file an appeal of an action with the plan orally or in writing. When the plan sends you a letter about an action it is taking (like denying or limiting services, or not paying for services), you must file your appeal request within 60-calendar-days of the date on our letter notifying you of the action. If we reduced, suspended, or stopped services you are getting now, you must file your appeal 10 days from the date of our letter notifying you of the decision, or by the effective date of the decision, if you want to keep your service the same until we make the decision on your appeal.
If you disagree with our decision on your appeal, you can ask for a Fair Hearing. In either case, the same 60 calendar day deadline applies. You can also ask for a Fair Hearing if we did not give you a decision on your appeal, or if we gave you a late decision. You must ask us for an appeal first before you ask for a Fair Hearing. You have 120 days from the date we gave you the appeal decision to ask for a Fair Hearing.
If we reduced, suspended, or stopped services you are getting now, you must ask for Fair Hearing 10 days from the date of our letter notifying you of the appeal decision or by the effective date of the decision, if you want to keep your service the same until the Fair Hearing decision is made.
How long will it take the plan to decide my appeal of an action?
Unless you ask for an expedited review, we will review your appeal of the action taken by us as a standard appeal and send you a written decision as quickly as your health condition requires, but no later than 30 days from the day we receive an appeal. Expedited review will be made within 72 hours of receipt of the appeal. (The review period can be increased up to 14 days if you request an extension or we need more information and the delay is in your interest.) After receiving your appeal, we will send you the case file associated with your appeal. The case file includes medical records, documents, records or any new or additional information considered, used or created in connection with the initial denial that will be used to make the appeal decision. If you would like to review the case file with us, you can call us to set up a date and time for you and/or your representative to review the case file. During our review, you will have a chance to present any supporting information. We will send you a notice about the decision we made about your appeal that will identify the decision we made and the date we reached that decision.
Please refer to your member handbook for additional details or call Member Services and ask to speak to your Care Manager who will guide you through the process.
How do I make a complaint?
If you have a problem with the care or treatment you receive from our staff or providers or you do not like the quality of care or services you receive from us, call Member Services at 718-759-4510. You can also write us with your complaint at:
6323 Seventh Avenue, 3rd Floor
Brooklyn, NY 11220
Attn: Member Services
Most problems can be solved right away. If it cannot be resolved right away, it will be reviewed by one or more qualified people and we will let you know our decision in 45 days of when we have all of the information we need to answer your complaint, but you will hear from us in no more than 60 days from the day we get your complaint. If you disagree with a decision we made about your complaint, you or someone you trust can file a complaint appeal. Please see your member handbook or call Member Services for more information.