Effective 01/01/2019 Moun St Luke's & West (Roosevelt) 1199 Union ADAP (opd only) NYS HIV program NYS HIV program Aetna U.S.Healthcare Insurance Co. HMO/POS/ Y Y Indemnity Y Y NYC Community Plan Y Y International plans Y Y Medicare Y Y Student Health Y Y Affinity Medicaid/ Signature Administrators Y Y Savings Plus Y Y Aetna Whole Health ACO Y Y ACO effective 1/1/17 HARP Family Health Plus Y Y Beacon Beacon N N N N N Y Y Beacon Beacon Y Y Beacon Beacon Y Y Beacon Beacon Y Y Beacon Beacon HIX QHP Alphacare FIDA Empire Healthplus (formerly Medicaid Y Y Amerigroup Community Care and HARP N N N N N Amerigroup New York (formerly Medicare Y Y Careplus)) Y Y c AmidaCare Y Y Family Health Plus Y Y SNP HIV SNP (VNS) ArchCare Medicaid/ Senior Life/PACE N N N N N BCE Emergis (up & up) N N N N N Beech Street (Multiplan), Leased network Best Doctors, Leased network Bright Health Medicare Medicare Brighton HPN CREATE N N N N N Effective 1/1/19 (EXCHANGE PRODUCT DISCONTINUED) January 2019 Contracted Payers Page 1
Moun St Luke's & West (Roosevelt) Centerlight (CCM) PACE Cigna, includes Great West Insurance Co. HMO/POS Y N Y Y N Y N Y Y N ChoiceCare, Leased network Connecticare, Inc.Connecticare of New HMO/POS Y Y Value Option Value Option York, Connecticare of Massachsetts (Part Y Y Value Option Value Option of Emblem) Medicare Y Y Value Option Value Option Medicaid N N N N N Medicare SNP Y Y Value Option Value Option Coventry National Provider Network, Coventry Health Care Commercial, Network Access, Worker's Compensation, Automobile Insurance Managed Care Individual/Family Crystal Run N N N N N Medicaid Fresenius ESRD / Medicare Effective 1/1/17 Dikla International International Y N Y Y N Direct Care America (health smart Insurance Co., EPO network) Elderplan Emblem Insurance Co. CompreHealth HMO, Y Y Use Value Options Use Value Options CompreHealth, Y Y Use Value Options Use Value Options Y Y Use Value Options Use Value Options EmblemHealth /EPO Y Y Use Value Options Use Value Options Empire BC/BS Insurance Co. HMO/POS Y Y EPO/ Y Y Indemnity Y Y Medicare ( Senior Plan) Y Y Y Y Empire Plan NYS Employees Y Y Pathway & Pathway x Y Y Englewood Hospital Self Insured Plan N N N N N Fidelis Medicaid/ Medicaid Y Y HARP Y Y Y Y Family Health Plus Y Y Y Y Y Y First Health (formerly Affordable) NY State of Health HBX Y Y N N N N N Access through Coventry at SLW, BI, and January 2019 Contracted Payers Page 2 of 5
Moun St Luke's & West (Roosevelt) Fresenius Medicare Advantage SNP GHI HMO/POS Y Y Use Value Options Use Value Options Network Access Y Y Use Value Options Use Value Options Flex/Select Y Y Use Value Options Use Value Options Y Y Use Value Options Use Value Options EPO/ Y Y Use Value Options Use Value Options Global Medical Management Insurance Co. N N N N N HealthFirst Medicaid Y Y HARP Y Y A+ Y Y Y Y Y Y Commercial Product HFIC Y Y Family Health Plus Y Y Life Improvement Plan, Increased Benefits Plan, Maximum Plan, Coordinated Benefits Plan, 65+ Y Y Flex/Select Discontinued 4/1/2011 Leaf Y Y H.I.P. Insurance Co. HMO/POS Y Y Use Value Options Use Value Options Y Y Use Value Options Use Value Options Medicare HMO Y Y Use Value Options Use Value Options Medicare SNP Y Y Use Value Options Use Value Options Medicaid Y Y Use Value Options Use Value Options HARP Y Y Use Value Options Use Value Options Family Health Plus Y Y Use Value Options Use Value Options Y Y Use Value Options Use Value Options Humana Select Care Y Y Use Value Options Use Value Options Medicare Advantage plan Independence Care System Medicaid Outpatient Contract only covers rehab, respiratory services, dental, Y N Y Y N podiatry, audiology and nutrition. (LIMITED SCOPE) FIDA Y N Y Y N All other services are paid by primary carrier. LifeSource (CIGNA) Specialty Transplants Transplants N N N N N LifeTrac Specialty Transplants Transplants Magellan Specialty Behavioral Health Behavioral Health MagnaCare (ex Global Excel all sites, local 272 non par for BISLW & NYEEI only) Managed Health Network (MHN) HMO Behavioral Health Behavioral Health N N N N N N Y N N Y N Y N N Y N Y N N Y N Y N N Y MetroPlus Medicaid Y Y But Use Beacon But Use Beacon PATIENT MUST VERIFY WITH FACILITY IF COVERED UNDER A LOCAL WELFARE FUND January 2019 Contracted Payers Page 3 of 5
Moun St Luke's & West (Roosevelt) HARP Y Y But Use Beacon But Use Beacon Metroplus (cont'd) MSH NY SPECIALTY SERVICES ONLY (NO PCP'S ENROLLING) MSBISLR ALL SERVICES Medicare Y Y But Use Beacon But Use Beacon FIDA Y Y But Use Beacon But Use Beacon Y Y But Use Beacon But Use Beacon Managed Long Term Care Y Y But Use Beacon But Use Beacon Y Y But Use Beacon But Use Beacon Family Health Plus Y Y But Use Beacon But Use Beacon HIV SNP (Partnership in Care) Y Y But Use Beacon But Use Beacon MetroPlus Gold I & ll Y Y But Use Beacon But Use Beacon Citycaid Y Y But Use Beacon But Use Beacon Exchange Plan Market Plus Y Y But Use Beacon But Use Beacon SHOP, QHP, Other s Y Y But Use Beacon But Use Beacon Multiplan (EX Global Excel), Leased network MVP ( ONLY) Insurance Co. Medicaid Medicare Oscar Health Plan Oxford Health Plan Insurance Co. Freedom, Liberty HMO/POS Freedom, Liberty TPA, PLEASE Verify Client List Y N Y Y N Follow Cigna Contract N N N N N N N N N N N N N N N Y Y (will be using Optum) (will be using Optum) Y N Y Y N Y N Y Y N Y N Y Y N Exchange product SHOP POMCO Insurance Co. Private Healthcare System, Leased network (PHCS Multiplan) Savility Proamerica Managed Care Insurance Co. Y Y Y N N Senior Health Partners Medicare Pace Program N N N N N Select Health (VNS Choice) SNP HIV SNP Select PRO Insurance Co. Senior Whole Health Special Needs Plan Medicare Medicare / Medicaid Advantage N N N N N Medicare / Medicaid Advantage Plus N N N N N January 2019 Contracted Payers Page 4 of 5
Moun St Luke's & West (Roosevelt) Managed Long Term Care Plan N N N N N Touchstone Y Y Y N N Tricare/Champus Military Military United Health Care (UHC) Insurance Co. HMO/POS Y N Y Y N Y N Y Y N Empire Plan NYS Employees Y N Y Y N UHC Y N Y Y N Nursing Home Plan (HMO SNP) Y N Y Y N Medicare HMO (complete Focus) Y N Y Y N Medicare HMO Y N Y Y N United HealthCare Community Plan of NY Y N Y Y N HARP N N ( formerly knows as Americhoice) Y N Y Y N Y N Y Y N Family Health Plus Y N Y Y N Compass (for the Complete Focus product line, the patient MUST activate their Passport Benefits via UHC) BISLW & NYEEI will disenroll in compass effective 2/1/17 UMR Y United Resource Network (OptumHealth) Specialty Transplants Transplants N N N N N Vytra HMO/POS N N N N N N N N N N Medicare HMO N N N N N Medicare SNP N N N N N WellCare Insurance Co. Medicaid HARP N N N N N Family Health Plus Medicare Exchange Exchange VNS Special Needs Plan Medicare Choice Preferred Choice Enhanced Choice Total Village Care Medicare Advantage and FIDA VNS Medicare product is exiting the market place effective 1/1/2019. PLEASE NOTE: FOR THE MEDICAID HMO'S. EXCEPT FOR SENIOR HEALTH PARTNERS, ICS AND HIP MEDICAID, FOR ALL HOSPITAL CLINICS, INDIVIDUAL PHYSICIANS MUST BE CREDENTIALED WITH EACH PLAN IN ORDER FOR THEIR CLAIMS TO BE PAID AND SERVICES AUTHORIZED. j g y y p y y y p y y plan are both covered under your benefits. If you have any questions, please contact the Insurance Carrier, your physician or the facility. In accrodance with New York Law, this information must be made available upon request. Financial Responsibilities are specific to your policy. Payment of the responsibility as assigned or identified by your insurance carrier will be due upon request January 2019 Contracted Carrier Listing to Hospital, Beth Israel, West, St Luke's and the New York Eye and Ear Infirmary at January 2019 Contracted Payers Page 5 of 5