| Par-provider listing
errors trigger reimbursements By DEBORAH STAYMAN If you were forced to make higher co-pays for using a medical provider listed erroneously as participating in the Empire Plan provider network, you may get some of that money back. Empire Plan administrator United HealthCare (UHC) has agreed to correcting the errors in its directories of participating providers, and to review claims going back to January 2000 to find all of those that were improperly processed and reimburse enrollees who paid too much because of the directory errors. These errors, which UHC attributed to computer programming problems, first occurred in 2000 and were included in its published directories until October 2005. The errors were corrected in the online directory in May 2004. The corrections and reimbursements are the result of a settlement reached last December between UHC and the state attorney general. UHC also agreed to pay $20,000 in penalties and $25,000 in costs. The case began when the AG’s Health Care Bureau received a complaint from a woman who had received services from a doctor erroneously listed as participating in UHC’s Empire Plan network. Because UHC charged her for using out-of-network services, she had to pay much more than the copay for using an in-network doctor. An investigation revealed UHC erroneously listed certain doctors as participating in the Empire Plan at certain locations and the state Department of Civil Service relied on that erroneous information in its written and online directories of providers for Empire Plan members. If you believe you have a claim that was improperly processed, call UHC at 1-877-7NYSHIP (1-877-769-7447). Manage health benefits online State employees can now use a new self-service Web site, operated by the state Department of Civil Service, to manage their health insurance benefits. All state employees can use a secure log-on process to access the MySHIP (My State Health Insurance Program) site at any time to review medical, dental, and vision benefits information, request new insurance cards, and update their home address with the NYS Health Insurance Program. MySHIP is being phased in over three years. Future enhancements are expected to offer users online enrollment and option transfers. Use a a DCS user identification and password to log-on at www.cs.state.ny.us/myship. Multiple levels of verification will authenticate your identity. Once you are logged on to MySHIP, you may request an activation code be sent to you by mail that will allow you to perform future transactions including change of address. — Sherry Halbrook |
2006 health care
claims due March 31 By LORRAINE SIMPKINS March 31 is the last day to submit your 2006 Empire Plan health care claims for reimbursement. Submit your claims to: • United HealthCare for the Empire Plan Basic Medical Program, the Home Care Advocacy Program, and for non-network physical medicine services; • ValueOptions for non-network mental health and substance abuse services; • Caremark for prescriptions filled in 2006 at non-participating pharmacies or without using your Empire Plan Benefit Card. If the Empire Plan is your secondary insurer, you must submit claims by March 31 or within 90 days after your primary health insurance plan processes your claim, whichever is later. If you are covered under the Empire Plan as both an enrollee and as a dependent, you may submit secondary claims to the Empire Plan for expenses not reimbursed under your primary coverage, such as copayments (including prescription drug copayments), deductibles and coinsurance amounts. Claims submitted after the deadline will be rejected. The carriers will only reconsider their denial of these claims if you provide documentation indicating it was not reasonably possible for you to meet the deadline (for example, due to illness). Claim forms are available from your agency health benefits administrator, or by calling the Empire Plan at 1-877-7NYSHIP (1-877-769-7447), or online at the state Civil Service Department’s Web site www.cs.state.ny.us/ebd. Click on Using Your Benefits and then on Forms. Mail completed claim forms with supporting bills, receipts and, if applicable, a Medicare Summary Notice or statement from your other primary insurer to: • United HealthCare P.O. Box 1600 Kingston, New York 12402-1600 • ValueOptions P.O. Box 778 Troy, New York 12181-0778 • The Empire Plan Prescription Drug Program P.O. Box 52071 Phoenix, AZ 85072-2071. |
The Communicator March
2007
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Marchers
rally for Suny Upstate
Nurses:
Lobby Day is May 22
Stopping
attacks at Bronx PC
March is
Woman's history month
O'Connel
loses Senate bid
Accident
takes council leader
Vacancy;
Admin. Exec.
Oops! The February issue
mistakenly identified member Sue Jeffords as retired; incorrectly referred to
PEF Division 239 as Division 283; and omitted that retired thoroughbred C.L. Rib
ran 93 races and hit the tote board 51 times.
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