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Apr 30, 2024 · The Empire Plan hospital carrier, Anthem Blue Cross will review the setting for infusion services under The Empire Plan Hospital Program and, if clinically appropriate, work with you, your patient and UnitedHealthcare to transition those services from an outpatient hospital setting to a new location. Alternate settings include freestanding ...
The Empire Plan Medical/Surgical Program right in your hands using the UnitedHealthcare® (UHC) app? Find care and compare costs for participating providers and services in The Empire Plan network. You can also view your claims and check your deductible and out-of-network balances. The UHC app helps you get the most out of your benefits
- Elimination of Multiple Participating Provider Copayments Per Visit
- Change in Maximum Allowed Amount For Nonparticipating Providers
- New Site of Care Program For Infusions
- Visit Limit Added For Out-Of-Network Acupuncture Services
- Visit Limit Added For Massage Therapy Services
- A New Center of Excellence For Substance Use Disorder Program
- Questions?
The $25 participating provider copayment amount remains the same, with multiple copayments for the same provider and same visit eliminated. Just 1 copayment of $25 is required for all covered office visits, office surgery, radiology and/or laboratory services received by the same enrollee from the same provider on the same date of service. Please n...
Claims from nonparticipating providers will use Medicare rates as the fee basis. This means enrollees may have greater out-of-pocket costs when using a nonparticipating provider. In accordance with your contract, please refer enrollees to providers in The Empire Plan network when appropriate. Using network providers will help your patients avoid ad...
If an enrollee receives infusion services for infliximab (Remicade®) or an infliximab biosimilar and The Empire Plan is the enrollee’s primary coverage, Empire BlueCross will review the setting for those services under The Empire Plan Hospital Program. If clinically appropriate, Empire BlueCross and UnitedHealthcare will work with you and your pati...
Coverage is available for a maximum of 20 visits per calendar year for acupuncture services by nonparticipating providers. This is a combined total for all nonparticipating providers, regardless of how many nonparticipating providers are visited. The 2023 visit maximum does not include visits prior to July 1, 2023.
Coverage is available for a maximum of 20 visits per calendar year for massage therapy services. This is a combined total for all massage therapy visits, regardless of how many providers are visited. The 2023 visit maximum does not include visits prior to July 1, 2023.
The Empire Plan Mental Health and Substance Use Program, administered by Carelon Behavioral Health, will include a new Center of Excellence for Substance Use Disorder Program in partnership with the nationally recognized Hazelden Betty Ford Foundation. The program provides authorized treatment services at no cost to The Empire Plan enrollees. Detox...
Call 877-769-7447 (877-7-NYSHIP) and press or say “1” to reach the Medical/Surgical Program, administered by UnitedHealthcare.
EPIC Hearing Healthcare Hearing Service Plan (HSP). Call toll-free 1-866-956-5400 to locate the nearest hearing aid service center and to access your Empire Plan benefit through the EPIC Hearing Service Plan. If The Empire Plan is your primary insurance coverage and use a nonparticipating provider who is part of the MultiPlan group, your out-of ...
People also ask
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If The Empire Plan is primary for you or your covered dependents, you must call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the Medical/Surgical Program (administered by UnitedHealthcare) before receiving the following scheduled (nonemergency) diagnostic tests: • Magnetic resonance imaging (MRI)
Oct 1, 2023 · Reimbursement. Your reimbursement for The Excelsior Plan and SEHP members is the same as it is for The Empire Plan based on your Payment Appendix. If you are directly contracted with The Empire Plan, use the reimbursement listed directly in your agreement. If you are a preferred provider organization (PPO) health care professional, use the ...
Always ask your provider if he or she is a participating provider before you receive services. For physical therapy and chiropractic services, managed care components of The Empire Plan, you are guaranteed access to a participating provider. Call 1-877-769-7447 if you need help locating a participating provider in those specialties.
