Cost-sharing amounts attributable to services received from Non-Participating Providers generally do not count toward MOOP. MOOP includes deductibles, coinsurance, and copay charge amounts that you must pay for covered in-network services and any applicable riders in a calendar year. 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.
EMPIRE BLUE CROSS HMO DFIND A DOCTOR PLUS
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. All other specialty providers: $30 copay.$0 copay at an AdvantageCare Physicians provider or Montefiore faculty-based center.No required primary care physician (PCP).GHI CBP offers great coverage everyone can afford. This chart shows the estimated cost of seeing a doctor outside of our network.
EMPIRE BLUE CROSS HMO DFIND A DOCTOR PROFESSIONAL
Using a health care professional in our network is a cost-effective way to use this plan. Ask your doctor for the medical procedure codes (CPT Codes) of the services you need. If you choose to get services outside of our network, you can use the GHI CBP Allowance Calculator at /GHICBPcalculatoror call 80 to estimate how much EmblemHealth will reimburse you for the service. 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. The GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors.