Navigating your healthcare options under the NYS Empire Plan can feel overwhelming, especially when you need to find the right doctors and providers. The Empire Plan is structured to offer comprehensive medical care, and understanding how to locate participating doctors is key to managing your healthcare costs effectively. This guide will walk you through the different programs within the Empire Plan and show you how to find the best Nys Empire Plan Doctors and healthcare services for your needs.
Accessing Medical and Surgical Doctors
The Medical/Surgical Program of the Empire Plan, administered by UnitedHealthcare, is designed to give you broad access to medical care. A crucial aspect of this program is utilizing participating providers. Choosing doctors and surgeons within the network helps ensure that both you and the Empire Plan maintain reasonable healthcare expenses.
To assist you in finding in-network medical/surgical providers, UnitedHealthcare provides a comprehensive and regularly updated directory. This directory is an essential tool for enrollees looking for NYS Empire Plan doctors, including specialists, primary care physicians, and surgeons. Beyond doctors, the directory also lists laboratories, outpatient surgical centers, cardiac rehabilitation facilities, urgent care centers, and orthotic/prosthetic device networks.
The Empire Plan Medical/Surgical Provider Directory
UnitedHealthcare also offers a personalized website, MYUHC, specifically for Empire Plan enrollees. This platform is a valuable resource for tracking your medical/surgical claims, viewing your claim history, printing explanations of benefits (EOBs), and, importantly, creating custom directories of providers. This feature allows you to pinpoint NYS Empire Plan doctors who meet your specific location and specialty requirements.
For hearing-related needs, the Empire Plan partners with EPIC Hearing Healthcare Hearing Service Plan (HSP). To find hearing aid service centers within your network and access your Empire Plan benefits for hearing care, you can call EPIC Hearing Healthcare toll-free at 1-866-956-5400.
Hospital Program and Network Doctors
The Empire Plan Hospital Benefits Program, managed by Anthem Blue Cross and BlueShield, operates with two benefit levels: network and non-network. To maximize your benefits, it’s advantageous to use hospitals, hospices, and skilled nursing facilities that are part of the BlueCross and BlueShield Association’s network. This network is extensive, encompassing a vast majority of hospitals across the United States. Specifically, 97% of hospitals nationwide are within this network, giving Empire Plan enrollees broad access to hospital care and associated doctors. Network coverage also extends to select New York hospital-based ambulatory surgical centers and hospital-owned urgent care centers, further expanding your options for in-network doctors and care.
The Empire Plan Hospital Program Website and Directory
Mental Health and Substance Use Doctors and Providers
For mental health and substance use services, the Empire Plan is administered by Carelon. This program provides coverage for medically necessary inpatient and outpatient care through a network of participating mental health professionals and facilities. Crucially, coverage also extends to medically necessary non-network services. However, to ensure you receive the highest level of benefits and find the right NYS Empire Plan doctors or therapists for mental health and substance use care, it is recommended to contact Carelon before seeking treatment. This proactive step is advised even if you have a referral from another doctor.
Carelon offers a Clinical Referral Line to assist you in finding a network provider and coordinating your care. By using this service, you are guaranteed access to network-level benefits. You can reach the Clinical Referral Line 24/7 by calling The Empire Plan toll-free at 1-877-7-NYSHIP, choosing option 3 for the Mental Health and Substance Use Program (MHSU), and then selecting option 3 again from the MHSU Program menu. This service is invaluable for finding NYS Empire Plan doctors and mental health professionals best suited to your needs.
Carelon also provides a confidential online portal where you can access a directory of mental health providers and facilities, educational resources, screening tools, disease management programs, and information about your claims and coverage. This online resource is another way to locate NYS Empire Plan doctors and manage your mental healthcare.
The Empire Plan Mental Health and Substance Use Program Website and Directory
Prescription Drug Program and Pharmacy Services
While the Prescription Drug Program is primarily focused on medications, it’s important to understand how it integrates with your overall healthcare under the Empire Plan. Administered by CVS Caremark, this program allows you to manage your prescription costs effectively. You can order prescriptions through mail service, potentially reducing your expenses and the Plan’s costs. The program also provides information on pharmacy locations, including those participating in vaccine networks and offering 24-hour services. While not directly about doctors, pharmacists are crucial healthcare providers, and CVS Caremark’s network ensures access to pharmacy services under the Empire Plan.
Empire Plan Prescription Drug Program website
Utilizing Nonparticipating Providers and Potential Discounts
In situations where you utilize a nonparticipating provider for your primary insurance coverage through the Empire Plan, there’s a potential benefit. If the nonparticipating provider is part of the MultiPlan group, your out-of-pocket expenses may be reduced in many cases. This can be particularly helpful when accessing specialists who may be outside of the primary Empire Plan network but are within the broader MultiPlan network. While it’s always best to prioritize in-network NYS Empire Plan doctors, understanding the MultiPlan option provides flexibility and potential cost savings when using out-of-network providers.
Basic Medical Provider Discount Program Directory
Finding the right NYS Empire Plan doctors and navigating the provider networks is a crucial step in effectively using your healthcare benefits. By utilizing the directories, websites, and referral lines provided by UnitedHealthcare, Anthem Blue Cross and BlueShield, and Carelon, you can confidently access the medical care you need while maximizing your Empire Plan benefits.
