|
Insurance and Coverage
In addition to Medicare and New York State Workers Compensation, HSS Radiologists are participating providers in a variety of Insurances plans. Please note that insurance companies and insurance plans are constantly changing and it is impossible to know the exact coverage limitations for any particular individual plan. It is the patient's responsibility to know the limitations of coverage for radiological tests provided under their specific insurance plan. Please consult with your benefit administrator if you have any questions.
In addition to accepting Medicare, Medicaid, NY State Workers Compensation & No-Fault coverage, below is a summary of Managed Care participation for the Radiologists & the Department of Radiology and Imaging:
Questions regarding specific benefit levels and/or patient responsibility levels for imaging services at HSS should be routed as follows:
Verification Unit: 212-606-2561
Benefit Coordinator: 212-606-2607
HSS Radiologists Managed Care Contracts
as of August 2, 2007
|
COMPANY
|
PLAN TYPE*
|
| Beech Street
|
Participation status depends on patient's individual plan
|
| CIGNA Health Plans (as of 5/15/07) |
HMO
POS
Network
All "Open Access" Plans
EPO
PPO
Indemnity
|
Empire Blue Cross
Blue Shield |
PPO
EPO
Indemnity
NYC Healthline
Empire Plan (NYS Gov't Employee Benefits)
Federal Employee Program
Out of Area (cards with a  logo)
WellPoint PPO / EPO / Indemnity
UniCare Affiliated PPO
Non-Participating:
HMO
POS
Senior Plan (Medicare HMO)
Child Health Plus (CHP)
Family Health Plus
|
| MultiPlan |
Participation status depends on patient's individual plan
|
| The New York-Presbyterian Comm Health Plan |
Medicaid HMO
Child Health Plus (CHP)
Family Health Plus
|
| Oxford Health Plans |
Freedom Network
Liberty Network
Medicare Advantage
|
Private HealthCare Systems (PHCS)
|
All Plans |
| United Health Care |
HMO (Choice, Select Plus)
POS (Choice Plus, Select Plus)
PPO / EPO / Indemnity
Non-Participating:
Medicare HMO
Medicaid HMO
Child Health Plus (CHP)
Family Health Plus
|
OTHER PLANS
If the Hospital does not participate with a specific plan, coverage may still be available subject to the availability of "Out of Network" Benefits. Please confirm this information with the plan.
*For all plans above, due to individual plan requirements, some members may have limited coverage for certain outpatient services. Please contact the members' Plan to confirm individual Plan/Benefit requirements.
* For all plans above, due to individual plan guidelines, members may still incur out of pocket expenses for deductibles, coinsurance and non-covered services even if HSS Participates in their plan. |
|
Has your doctor ordered an MRI, CT, DEXA, Ultrasound or Nuclear Scan that requires preauthorization?
A few words about preauthorization:
Insurance carriers increasingly require prior authorization by their medical review departments or written referrals from your primary care physician before payment for MRI, CT scans, Densitometry, Nuclear Scans or Ultrasound studies will be approved. They will not approve payment for authorizations requested after services are provided.
Information required by your insurance company minimally includes the following. Please note: your carrier may require that some of this information come from the office of the ordering Physician:
- Your Name
- Your Member ID Number
- Your Ordering Physician's Name
- Principal Diagnosis / Signs and Symptoms
- History of Prior Treatment
- Secondary or Additional Insurance Coverage
- Ordered Procedure Code
- Scheduled Date of Service
- Facility Where Services Will be Rendered
You must ensure that any required approvals, pre-certifications, and/or primary care physician referrals are secured prior to your service date. If these requirements are not met, the examination will not be performed unless you remit payment in full at the time of service.
Please call our pre-registration department at 212-606-2561 if you require assistance with this process, or if you wish to discuss acceptable payment options.
For billing inquiries please call 212-606-1975 or toll free
at 1-866-689-8865.
|
