Benefits and Services of Elderwood Health Plan

Once you enroll in the plan, your care management team coordinates all benefits and services with you, your family and your doctors. Through regular follow-ups, the care manager monitors your condition, so if your needs change, your service plan will change to give you the right benefits. For coverage details on any benefit or service listed below, please see your Member Handbook.

HEALTH AIDE AND NURSING CARE

  • Care Management
  • Consumer Directed Personal Assistance Services (CDPAS)
  • Home Health Aide
  • Home Health Care
  • Home Health Nurse
  • Medical Social Services
  • Nursing Home Care
  • Personal Care
  • Private Duty Nursing Services
  • Telehealth

DAY PROGRAMS

  • Adult Day Health Care
  • Social Day Care

SPECIALISTS

  • Dentistry
  • Optometry/Eyeglasses
  • Foot Care/Podiatry
  • Audiology/Hearing Aids

NUTRITIONAL SERVICES

  • Home Delivered or Congregate Meals
  • Dietary Counseling
  • Medical Nutrition

EQUIPMENT AND SUPPLIES

  • Durable Medical Equipment
  • Medical Supplies
  • Personal Emergency Response Systems (PERS)
  • Prosthetics and Orthotics

THERAPY

  • Occupational Therapy
  • Physical Therapy
  • Rehabilitation Therapies (Outpatient)
  • Respiratory Therapy
  • Speech Therapy

OTHER

  • Social and Environmental Supports
  • Non-Emergency Medical Transportation

 

Emergency Care

You DO NOT need prior authorization for any emergency care. Emergency care is not a benefit of Elderwood Health Plan.  Hospitalization and emergency room care fall under Medicare and/or Medicaid covered services.

 

Out-of-Service Area Care

If you are planning to spend time away from home or are in need of care outside of the Elderwood service area that includes Erie, Niagara, Monroe, Orleans, Genesee, and Wyoming counties, please contact your care manager immediately. We will make every effort to arrange temporary services for 30 days or less.

 

Services Not Covered by Elderwood Health Plan

The following are services usually covered by Medicare or Medicaid. Your care manager will help you coordinate these benefits in addition to those you receive through Elderwood Health Plan.

  • Ambulance
  • Inpatient, Outpatient and Emergency Room Hospital Services
  • Physician Services
  • Laboratory Services
  • Chiropractic Care
  • Chronic Renal Dialysis
  • Medication – Prescription/Nonprescription
  • X-Ray/Radiology Services
  • Rural Health Clinic Services
  • Mental Health Services
  • Alcohol and Substance Abuse Services
  • Family Planning Services

 

Elderwood’s Provider Network

Elderwood offers a wide provider network to administer the care you need. Once a service plan is outlined, you and your care manager will select appropriate providers from this network. You may involve your primary care physician in this selection process, if desired. To find providers near you who participate in the Elderwood Health Plan, please use our Provider Tool.

 

Out-of-Network Providers

New members receiving home care services from out-of-network providers have a transition period to cover these out-of-network services. After the transition period, services by out-of-network providers are not a covered benefit unless authorized. If you are receiving home care benefits or services from an out-of-network provider, speak with your care manager to request these services. You may also request to add a provider to the Elderwood Health Plan network. While there is no guarantee the provider will agree to participate, we will make every effort to encourage them to join our network.

 

Requesting Authorizations

Prior authorization is needed to add new or additional benefits to what is outlined in your service plan. If you require benefits from an out-of-network provider, you must contact your care manager to request authorization in advance, before receiving care. If the provider and/or service is not approved in advance of your visit, you will be responsible for paying those charges.

All requests should be directed to your care manager and can be made verbally or in writing. Expedited authorization is available if any delay in decision could jeopardize your health. In an emergency, you may seek care without prior authorization.

 

Payment

Some Medicaid members have a monthly spend-down or surplus payment to maintain Medicaid eligibility. This amount is determined by the local department of social services. Because Elderwood Health Plan is a Medicaid program, we are required to collect this payment, and will send a monthly bill for the amount owed. Failure to pay this amount may affect your eligibility for Medicaid and Elderwood Health Plan benefits.

Send payment as a check or money order to: 

Elderwood Health Plan
Attn: Finance Department
7 Limestone Drive
Williamsville, NY 14221