The following is a list of the major insurance plans or networks in which our Practice presently participates. Note that our practice has no participation in any of the Plans offered through the Health Insurance Marketplace (Affordable Care Act policies).
If you do not see your insurance company/plan listed here then we do not participate in it. For up to date participating insurance information, please contact our Billing Office by phone or email.
If you wish to be seen by a physician in our Practice and we do not participate in your insurance plan, we will assist you in completing claims for your possible reimbursement but please be aware you will be responsible at the time of service for payment. Note that some OUT OF NETWORK policies provide reduced benefits after your deductibles have been met. This means that you can still receive at least partial reimbursement from your insurance company for services you paid. With some policies, we are able to send the claims on your behalf; other policies require the patient to issue his/her own claims to avoid issues during processing.
We ask that you kindly present your insurance card or cards at the time of service. It is very important that you DISCLOSE ALL INSURANCE information so that we can better coordinate payment for your claims.
Aetna OPEN ACCESS
Aetna Managed Choice
Aetna HMO plans and some Open Access plans require electronic referrals from your Aetna Primary Care Physician (PCP).
Cigna OPEN ACCESS POS
The HMO part of Cigna and SOME POS require referrals from your Primary Care Physician (PCP) These can be just Scripts from your registered Cigna PCP.
Empire BCBS PPO
BCBS National PPO PROGRAM (excluding Pathaway X Enhanced, Blue Priority plans)
Empire BCBS HMO
Empire BCBS POS
Empire BCBS Senior Plan
The HMO part and some Senior Plans of Empire Health Choice require paper or electronic referrals from your BCBS Primary Care Physician. Please note that our office has no contract with out of state BCBS insurance. None the less the National PPO program or Blue Card PPO program (displayed on the card with a suitcase and the “PPO” inside of it ) will link those policies to our Empire BCBS PPO contract.
A small portion of Out of state BCBS policies like Horizon BCBS (NJ BCBS, BCBS DIRECT Access) and Anthem BCBS cards carry the Suitcase LOGO with the PPO inside but do not belong to the national PPO network. These are indication that the patient will have out of network benefits out of their plan’s home area.
HIP (excluding Medicaid policies)
HIP PRIME HIP HMO
Most HIP policies require electronic referrals. Note that you should advice our staff of who your referring doctor or center is before we can setup your appointment.
Does not require referrals, but you must disclose who is your referring doctor. Medicare patients that are being cared for at a Nursing Home (Skilled Nursing Facility) need to advise our staff. This will help provide services that are in accord with your healthcare status at the time of service. You are also required to disclose any other insurance you may have to cover your Medicare Co-insurance and deductible. Your coordination of benefits must be up to date.
Oxford Freedom Select
Oxford Liberty Plan
Oxford HMO Plan
HMO and Liberty policies may require referrals. Some Freedom policies may use referrals if the patient wants to avoid deductibles and coinsurance. Freedom Select does not need referrals. Your insurance card will have a small black square on the back indicating your referral requirement or otherwise.
Oxford Medicare Advantage Policies have been absorbed by United Health Care. These policies may be difficult to identify as its not evident in the newer cards. Most of them have been grandfathered in through the United Health Care/Oxford merger in 2012. Note that your card might have an OXF on the back in a little black box to indicated your Oxford Network, to which we belong.
United Health Care (Excluding Medicare Complete and Medicaid policies)
United Health Care Choice
United Health Care Choice Plus
United Health Care Options PPO
United Health Care HMO requires the patient to have a United Health Care Primary Care Physician assigned. This PCP information needs to be disclosed to our staff at the time of service.
We make every effort to keep this information current and relevant. Also please be aware that having some insurance coverage does not imply that patients have no financial liability. Insurance policies and contracts are specific (and this changes frequently) in what they will and what they will not cover. If the insurance information submitted is not correct claims will be delayed, denied or assigned as part of your deductibles, co-insurance and co-pays. To receive the maximum of your insurance benefits, you must abide by all of your insurance requirements (e.g., referrals or pre-authorizations as required by your policy). Understanding your responsibilities, limitations and clauses of your particular policy will help ease your health care experience.
Note: the “PPO in the Suitcase” logo belongs to BCBS, it is presented for informative purposes only.