FAQ Table of Contents
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Who pays for home health?
MedSide is a Medicare-certified Home Health Agency. We also accept Medicaid, commercial insurances, and private payment. Please refer to your insurance policy for specific requirements related to your financial responsibility and prior authorization for treatment.
Medicare Coverage
If patient’s have Medicare, they can use their home health benefits if they meet all of the following conditions:
- Doctor must decide that they need medical care at home and make a plan for this care.
- Patient must need one or more of the following intermittent services:
- Skilled Nursing
- Physical Therapy
- Speech Therapy
- Patient must be homebound or normally unable to leave home unassisted. To be homebound means that leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to attend religious services. You can still get Home Health care if you attend adult day care.
If the patient meets the above conditions, Medicare will pay for their covered home health services for as long as they are eligible and your doctor says they need them. Skilled nursing care, therapy, and home health aide services are only covered on a part-time or “intermittent” basis. This means that there are limits on the number of hours per day or days per week that you can get skilled nursing, therapy, or home health aide services.
Medicare does not pay for the following:
- 24-hour-a-day care at home
- Meals delivered to patient’s home
- Homemaker services such as shopping, cleaning, and laundry when this is the only care needed, and when these services aren’t related to a plan of care
- Personal care given by home health aides like bathing, dressing, and toileting when this is the only care patient need.
Other Payor Sources
Benefits and restrictions vary from policy to policy. A physician’s order for skilled care will be required. Some plans require prior authorization for all services, and services provided without authorization cannot be provided unless the patient agrees to self-pay for these services at the private pay rates indicated below. Any balance due after your insurance company pays will be the patient’s responsibility. MedSide will bill the patient’s insurance. The patient is, however, responsible for copayments and deductibles, as well as any balance should the insurance company not cover the services billed.
Change of Eligibility
Should a patient no longer qualify for Medicare or Medicaid covered services or private insurance coverage, the patient will be notified by MedSide and care will continue ONLY at the patient's request. They will then become financially responsible for payment of any continued services paying privately for all services. They will be billed for services according to all criteria listed in Private Pay section of this handbook.
Private Pay
Patients may pay for services provided by MedSide
- In their entirety
- In addition to care being covered by another source.
- May pay for continuing care after insurance payments run out
Rates are determined by the type of services rendered. Hourly care rates vary. Payment arrangements will be agreed upon prior to services being rendered.
Who Pays for Personal Services?
Medicaid Waiver Programs for Personal Services
These programs are designed to provide care to enable the patient to remain at home versus nursing home placement. To qualify for the Medicaid Waiver coverage, patients must meet certain financial, age, and physical need requirements. These services must be ordered by a physician and authorized by a Waiver Case Manager.
Determining if you or a loved one qualifies for Medicaid services can be a confusing and daunting task. MedSide can help the client and their family screen for potential medicaid eligibility. If interested, you can send a message to This email address is being protected from spambots. You need JavaScript enabled to view it. to start a conversation now.
Private Pay
The patient may pay for services provided by MedSide
- May pay for services in their entirety
- May pay for other services in addition to care being covered by another source.
- Once services covered by your insurance have been discontinued, the patient may pay for continuing care
Rates are determined by the type of services rendered. Hourly care rates vary. Payment in full is expected in advance of the service. A deposit will be required and will be applied to your final invoice.
Who Pays for ADH Services?
Medicaid Waiver Programs for Non-Medical Services
These programs are designed to provide care to enable patients to remain at home versus nursing home placement. To qualify for the Medicaid Waiver coverage, the patient must meet certain financial, age, and physical need requirements. These services must be ordered by a physician and authorized by a Waiver Case Manager.
Private Pay
The patient may pay for services provided by MedSide
- may pay for services in their entirety
- may pay for other services in addition to care being covered by another source.
- Once services covered by your insurance have been discontinued, the patient may pay for continuing care
Rates are determined by the type of services rendered. Hourly care rates vary. Payment in full is expected in advance of the service. A deposit will be required and will be applied to your final invoice.
Are MedSide staff members available around the clock, seven days a week?
Yes. MedSide's services are available whenever you require care.
Does Medside serve my location?
MedSide provides services throughout the Metro Atlanta area including Fulton, Cobb, Delkalb and Gwinnett Counties. If you reside in one of the surrounding counties, please contact us for more information.
What are the requirements for MedSide’s staff?
All MedSide employees go through a rigorous background check, drug screening and clinical skill check-off. All employees are required to participate in continuing education throughout the year to further improve their skills in patient care.