New patient protections under states’ emergency medical services and surprise bill law they have received a surprise bill. The form outlines the situations that qualify as a surprise bill. To request the form, contact DFS or call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical Program. • Expenses that qualify to be a surprise bill will be considered by the plan at the in-network benefit level, subject to applicable co-payments. • Non-participating physicians who issue a surprise bill will only be able to collect the applicable in-network co-payment from enrollees. Utilization Review Disclosures Notifications or authorizations obtained through the Benefits Management Program for pre-certification and prospective procedure reviews will include Spring is finally here, and so is the time to begin planning your family’s summer trip. But before you travel, plan ahead on your family’s health care needs. Do you have your doctor’s phone number and your Empire Plan Benefit Card? Do you have enough of your regular medications? If you are Medicare primary, do you also have your Empire Plan Rx card? And, don’t forget to pack On the Road with The Empire Plan, which includes important information and phone numbers, as well as valuable tips for getting the most out of your coverage when you’re away from home. Empire Plan coverage is available worldwide, and not just for emergencies. Most parts of The Empire Plan have two levels of benefits. If you use an Empire Plan participating provider, you will receive A new state law that went into effect on March 31 helps protect New Yorkers from unexpected medical expenses. The state’s new Emergency Medical Services and Surprise Bills Law provides additional protections for patients who receive services from non-participating (non-network) providers. The following provisions of this law are effective for services provided on or after March 31, 2015. Emergency services The law includes new provisions for services provided in an emergency room in New York state: • Enrollees receiving treatment in the emergency room from the attending physician shall not incur costs greater than the applicable in-network co-payments. • Evaluation and management services provided by non-participating specialty physicians will no longer be subject to a deductible. However, other services provided by non-participating specialty physicians will be subject to a deductible. • In most circumstances, if a provider disagrees with the plan’s payment of benefits, they will have the right to file an appeal with an Independent Dispute Resolution Entity certified by the New York State Department of Financial Services (DFS). Surprise bills Another provision of the law protects patients from being responsible for paying the full charge for surprise bills when they are treated by non-participating providers without their knowledge. • Enrollees can complete an “Assignment of Benefits” form to notify the plan and provider that the following information when the provider of service is identified: • Whether the provider is a participating (in-network) or non-participating (non-network) provider; • The enrollee’s out-of-pocket expenses such as co-payment, deductible and/or coinsurance amounts; • If the provider is non-participating, the letter will include an estimate of what the plan will pay; and • An explanation of how to determine the usual and customary allowance. If you have any questions, please call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical Program. medically necessary covered services and supplies at little or no cost and have no claim forms to fill out. If you use a non-participating provider, medically necessary services and/or supplies are covered, but deductibles, coinsurance and benefit limits may apply. Know your plan and how it works away from home. Request an updated version of On the Road with The Empire Plan from your agency health benefits administrator. If you are a retiree, contact the Employee Benefits Division at 1-800-833-4344 for a printed copy to pack. On the Road with The Empire Plan can also be found online at www. cs.ny.gov. Click Benefit Programs, then NYSHIP Online, and then Using Your Benefits. From there, Click on Publications, where you will find On the Road with The Empire Plan. 16 The Work Force May 2015
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To see the actual publication please follow the link above