![]() ![]() MOOP refers to the maximum amount of in-network cost-sharing expenses that you will pay in each calendar year for covered services received from Participating Providers under the GHI/Empire BlueCross BlueShield plans combined. You will still pay any applicable out-of-network cost-sharing plus the difference between the provider’s fee and GHI’s reimbursement (which may be substantial).īenefits are subject to approval by the New York State Department of Financial Services. There will be no changes to your current out-of-pocket costs. **$100 for all other New York State facilities $50 for out-of-state facilities MRI/CAT/Hi-Tech Radiology: $50 copay for participating RadNet facilities, Zwanger-Pesiri Radiology, Memorial Sloan Kettering, and Hospital for Special Surgery**.All other specialty providers: $30 copay.$0 copay if you use an AdvantageCare Physicians (ACPNY) provider.Coverage for in-network and out-of-network services.This chart shows the estimated cost of seeing a doctor outside of our network. Using a health care professional in our network is a cost-effective way to use this plan. The calculator provides estimates for out-of-pocket costs, or what you may pay for certain items and services. If you choose to get services outside of our network, you can use our self-service treatment cost calculator available in the myEmblemHealth member portal. If you do not get a required prior approval, you may not get reimbursed. Hospitalization benefits are provided to you by Empire BlueCross BlueShield. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement, in addition to deductibles and coinsurance therefore, you may have a substantial out-of-pocket expense. This plan is offered to employees and non-Medicare eligible retirees and covers medical and surgical services. Most of the reimbursement rates have not increased since that time, and will likely be less (and in many instances substantially less) than the fee charged by the out-of-network provider. The reimbursement rates in the Schedule are not related to usual and customary rates or to what the provider may charge but are set at a fixed amount based on GHI’s 1983 reimbursement rates. When you choose to use out-of-network doctors, payment for covered services will be made under the NYC Non-Participating Provider Schedule of Allowable Charges. Using an Out-of-Network Health Care Professional In most cases, when you see a network doctor, your cost will just be a copay. ![]() You can see any network doctor without a referral. If you're unsure if your health plan covers mental-health services, call 65 and speak to a financial counselor who can help determine your coverage.The GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors. When you receive mental health services at El Camino Health, please be aware that you'll receive a separate bill for doctor's fees – psychiatrist fees are separate from hospital-program fees. Check your insurance ID card, and contact your insurance carrier to determine if your mental health benefits are carved out to another organization. For example, Health Net HMO members usually access MHN, a Health Net subsidiary. Some plans have a "carve out" for mental health benefits, which means these services are covered by a separate organization which you need to contact directly. Note – plans are subject to change without notice.Ĭoverage for mental health services varies by each health plan. Secure Horizons - Offered by UnitedHealthcareĮl Camino Health contracts with the following mental health insurance plans as of September 1, 2023. Covered California/Individual Family Planīlue Shield of California Promise Medicare Health Plan (Lithotripsy only)Įssence Healthcare (formerly known as Stanford Health Care Advantage)
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