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Understanding
Managed Care

It is important that you understand the basic requirements of your insurance plan. Different plans allow you to go out of network, some don't need referrals, some give prescription plans, most allow physicals.

Please find out from your benefits people what you are entitled to in your plan so we can best accommodate you. You can also link to your insurance company directly and they will be able to answer your questions.

Mary, ext 234, is the head of our billing department. She is the most knowledgeable staff member in regards to billing questions.

Different doctors in the office are on different plans, and in different capacities - specialist vs. primary care. The following list attempts to clarify which doctors in the office see patients in which plans.

 B

 PRIMARY CARE PHYSICIAN & SPECIALIST

 P

 PRIMARY CARE PHYSICIAN

 S

 SPECIALIST

This information was updated on  2/25/07

Plan

Yaffe

Ruden

Balboa

Haimoff

Lippin

Cooper

Travis

Aetna US Healthcare PPO/POS

B

P

 P

 

S

S

S

Aetna US Healthcare HMO

B

P

 P

 

 

S

S

Atlantis

B

 

 

 

 

 

 

Blus Cross Blue Shield HMO

s

P

 

P

 

 

S

Blus Cross Blue Shield PPO

B

P

P

P

 

 

S

Blus Cross Blue Shield Government: Healthy NY & Direct HMO

B

P

 

 

 

 

 

CIGNA Healthcare PPO

B

P

P

P

S

S

S

CIGNA Healthcare HMO

B

P

P

P

 

S

S

Commercical Insurances

B

P

 

 

 

 

 

Empire Plan New York: HMO/PPO Plans

B

P

P

P

 

 

 

GHI PPO

S

P

P

P

 

S

 

GHI HMO

S

P

P

 

 

S

 

HealthNet

B

P

 

 

 

S

S

HEALTH 1ST

P

P

 

 

 

 

 

HIP

S

P

 

 

 

 

 

Horizon

P

P

 

 

S

 

S

Medicare

B

P

 

 

 

 

 

Multiplan

B

P

P

P

 

 

 

Oxford

B

P

P

P

S

SP

 

PHCS

B

P

 

 

 

 

S

United Healthcare

B

P

P

P

S

S

S

United Healthcare Government: HMO/PPO Plans

B

P

 

 

 

 

 

Local 1199

 P

P

 

 

 

 

 

Insurance

Bone Density

Chest X-Rays

Bio-Feedback

Echo

Aetna US Healthcare

Yes: PPO Plans - Subject to Deductible

Yes: PPO Plans - Subject to Deductible

Yes: PPO Plan

Yes: PPO Plan & MC

Blus Cross Blue Shield (Including: Horizon & Anthem)

Depends On
Patient Contract

Depends On
Patient Contract

Depends On
Patient Contract

Yes: PPO Plan Only

CIGNA Healthcare

Yes: PPO Plans - Subject to Deductible

Yes: PPO Plans - Subject to Deductible

Yes: PPO Plan

Yes: PPO Plan Only

HealthNet

NO

NO

NO

NO

Medicare

Yes: Once per Year Only

YES

YES

YES

Multiplan

Yes: Must Call Insurance

Yes: Must Call Insurance

NO

Yes: PPO Plan Only

Oxford

Yes: Once per Year Only

YES

YES

YES

PHCS

Yes: Must Call Insurance

Yes: Must Call Insurance

 NO

 Yes: PPO Plan Only

United Healthcare

YES

YES

YES

YES

PPO Plans

Yes: Applied To Deductible

Yes: Applied To Deductible

Yes: Applied To Deductible

Yes: Applied To Deductible

Managed Care Websites

List of All Plans
http://www.healthplandirectory.com/HealthPlans/Directory/Default.asp
http://www.oxhp.com/  Oxford
http://www.aetna.com/index1.htm
http://www.bluecares.com/ 
http://www.unitedhealthcare.com/
http://www.phcs.com
http://www.selectpro.com/
http://www.cigna.com/healthcare/index.html
http://www.phshmo.com/home.htm
http://www.multiplan.com/
http://www.medicarehmo.com/?rURL=http://www.medicarehmo.com Medicare HMO info
http://www.anthem-inc.com Anthem Health Insurance (insurance company)
What is Managed Care?
Managed Care Re-Education - a Yaffe Ruden document
http://special.northernlight.com/managedcare/index.html#prof managed care update
http://www.money.com/money/101/lessons/17/flavors.html Understanding health Insurance
http://www.mceconnection.com/index.cfm Managed Care education directory
http://www.shriver.org/Service/CommunityFamilyServices/ManagedCare/index.htm
http://www.wnet.org/archive/mhc/Overview/essay.html
http://www.mcareol.com/inmcodic.htm  managed care dictionary
http://www.ahcpr.gov/consumer/hlthpln1.htm choosing a plan
http://www.aarp.org/monthly/managedcare/home.html
http://www.familiesusa.org/managedcare/consumer.htm#general
http://home.patientaccess.com/pac patient coalition for good healthcare
http://www.mcare.net/resources.html managed care resources
https://www.ehealthinsurance.com/cgi-bin/gx.cgi/applogic+Alliance?allid=INS10388&partne r=8&type=ALL insurance availability and info
http://www.insweb.com Insurance purchasing info
http://www.insweb.com/cgi-bin/gic.exe?id=SFhsNm9oeomvmNwHGJHRE3BW8O8&page=/ gic/faq/health-q.htj Insurance faq's
http://www.mybodyscan.com/features/hmos.cfm   Understanding how medical insurance reaaly works
http://insurance.yahoo.com Insurance center
http://insurance.com/insurance_options/health/health_index.asp health insurance quotes and info
http://www.mcare.net/brochure.html disability and managed care
http://www.dranonymous.com/links.html managed care empowerment
http://www.epn.org/ideacentral/health health policy
http://insurance.about.com/industry/insurance/cs/healthinsurance/index.htm Managed Care Information
http://www.aahp.org/AAHP/index.cfm?ContentID=95B8CC84-EAD2-11D3- QBDAD00A0C98ECA2F&Layout=Content&oid=E78B6532-B1AD-11D3-BDA400A0C98ECA 2F&JZXD=C4CA4238-A0B9-2382-0DCC509A6F75849B FAQ for health insurance
http://www.definedcare.com  defined care
http://www.definedcare.com/deflink.htm  defined care articles
http://www.mcol.com  managed care resource
Managed Care Legal Help
http://www.health.state.ny.us/nysdoh/mancare/appeal/std-desc.htm 
Medicare
http://hiicap.state.ny.us/medicare/index.htm
Feedback
http://planetfeedback.com/companyWrapper/0,1262,100-0-D,00.html Feedback to hmo's and hospitals