Fidelis Care accused of denying payments for home health services

Fidelis Care New York, a health care insurer that primarily serves poor and medically under-served people, has allegedly refused to pay a contractor for personal care services thousands of times.

J&K Healthcare Services, Mount Kisco, sued Fidelis and its parent company, New York State Catholic Health Plan, Nov. 2 in Westchester Supreme Court, demanding $438,851 for denying payments for services “for no intelligible reason.”

Fidelis did not respond to an email asking for its side of the story.

The nonprofit corporation, based in Rego Park, Queens, has more than two million members statewide, and provides services through government programs such as Medicaid and state children”™s health programs.

It is affiliated with Centene Corp., St. Louis, a publicly-traded corporation with a $39.6 billion market cap and net income of $2 billion over the past year.

J&K, formerly based in New Rochelle, employs caregivers who assist clients with medications, meal preparation, light housekeeping and bathing and grooming.

J&K and Fidelis struck a personal care services agreement in 2011.

J&K was required to submit claims for payments within 90 days of service, according to the complaint, and Fidelis had 30 days to pay.

Fidelis denied many claims, the complaint states, from 2014 to 2019.

“Nowhere in the denials did it establish any sort of good faith dispute,” the complaint states, “or notify J&K of the specific reasons why it was not obligated to pay.”

J&K says it promptly appealed, submitting corrected claims with documentation that backed up the original claims.

Fidelis allegedly denied the appeals thousands of times and declined to pay $438,851 for services rendered.

J&K accuses Fidelis of breach of agreement and violation of New York insurance law.

It is represented by White Plains attorneys Darius P. Chafizadeh and Daniel E. Guzmán.