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[EmblemHealth] Insurance Suck? Good? Rate? HMO vs POS Doctor Networks – 2020 Group Health Review

Emblem Health Insurance Review – 2020

This article is about our review for Emblem Group Health Insurance.

It contains the comprehensive information of

the plans pro & cons, specific plan information, 

how to Make Payment online or over the phone

Frequently Used Forms

FAQ

Find a Doctor 

Hospital List, and

& more…

EmblemHealth was created in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP).

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We are combining Public reviews from Google GMB (Google my business), BBB (Better Business Bureau), Public review from Yelp & our Broker insider insights to give you the single most comprehensive unbiased review.

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[click here] to see if you are qualify for free or $20 insurance.

I know health insurance premium is outrageous, however, we are not government employees or charities. We cannot apply Medicaid or other forms of free health insurance for you, the most we can do is to provide directions & resources on how to get them.

[Click here for more in Chinese] details information.

EmblemHealth is happy to offer its state-sponsored Medicaid Managed Care, HARP and Child Health Plus plan to eligible individuals and families throughout New York City, Long Island, and Westchester County.

That, however, is not what this article is about.

We are a broker for EmblemHealth commercial, small or large group insurance.

Hence, all of our information will be pertinent to the unsubsidized group health insurance only.

I am not sure if EmblemHealth has decided to waste a bunch of money to treat us, brokers, to splurge at this expensive hotel with two of the NBA Legends stars that helped the Knicks to its NBA title glory days.

I sure hope EmblemHealth hasn’t spent too much on the party & ended up doing this.

Emblem Health is implementing mandatory generic on all Small Group Prescription Drug Benefits

Emblem Health is after all…

A $10 billion insurance company with 3.1 million members with a very strong presence in NY.

EmblemHealth was created in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP).

Emblem Health Insurance: NY Affordable Health Coverage with Large Provider Network

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Because of coverage changes, EmblemHealth HMO reviews have varied significantly throughout the year. The company used to have extremely limited coverage– making it difficult to find doctors that accept their medical insurance.

However, this July, they greatly expanded their medical provider network to cover the tri-state area.

After these changes, Emblemhealth is a more affordable health insurance option in New York with good coverage.

In general, New York is not the best location to find affordable health insurance. As Trumpcare begins to slowly overtake the ACA, health insurance prices and rates are growing more costly.

This is partially due to the Obamacare mandate repeal, which eliminates the penalty for not having health insurance. As a result, fewer people are opting to buy health insurance and rates are rising.

That’s why Emblem’s healthcare provider expansion this July makes it a good bargain.

About Emblem Healthcare

Emblem Healthcare is based in Lower Manhattan and serves 3.1 million members. They are a major provider of Group Health Insurance to New York State.

Their service area includes New York City and surrounding locations as well as the tri-state area.

Emblem sells medical insurance including individual, family, and group plans, as well as Medicare. Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP) merged in 2006 to form Emblem.

This merger made them one of the largest not for profit insurers in the nation.

Emblem Health Insurance Plans

All of the EmblemHealth small group plans offer:

  • FREE THREE SICK VISITS
  • FREE TELEMEDICINE, not just COVID 19 related services, but for all Telemed related services.
  • FREE ACUPUNCTURE visits

Emblem Small Group Health Insurance Benefits NOT SUBJECT TO DEDUCTIBLE:

  • PCP Office Visits, copay applies
  • Urgent care visits, copay applies
  • Generic drugs, copay applies
  • Lab services, copay applies

Emblem offers only HMO plans– health insurance plans that come with a service network. The plans come in three categories:

Really Yucky Plan Design, Don’t like. Even their Platinum Choice has a [$200 Deductible]

 

  • Is this a scam?

In short, other than their Platinum Plan, all their Gold, Silver & Bronx plan has a deductible. Ewe…

Seriously, the only reason, if I were to go with them, is because:

My doctor is telling me to pick from either the Emblem Prime Network or one of the PPO Plans from either UHC or Empire.

EmblemHealth POS Network is cheaper than Oxford/UHC or BCBS PPO [Click to see for yourself]

However, if I were to pick the plan myself, I would rather go with a true PPO plan, (No Network) from either Oxford/Empire BCBS

PPO-vs-POS

PPO-vs-POS. For me personally, the minor cost-saving offered by Emblem doesn’t justify the trade-off [PPO vs POS].

EmblemHealth’s dramatic turnaround fueled by big real estate sales?

Well, since I don’t have $330 million cash or building, let’s get back to their networks.

Emblem Health Doctors

If you’re already a member, finding the right care is as easy as signing in to your myEmblemHealth account. You can search for doctors and facilities in your network and select and save a Primary Care Physician to your account for easy access in the future.

Learn more about our network selection criteria.

Emblem Health Dentist

We offer three dental plans to employer groups throughout New York State and to their employees who live in or out of the state.* These plans are preferred provider organizations (PPO) and are underwritten by Group Health Incorporated (GHI), an EmblemHealth company. Groups range in size from as few as five employees to thousands of covered patients. Without a referral, our members can seek care from any general dentist or dental specialist who participates with their dental plan.

Our dental plans are:

  • EmblemHealth Preferred Dental
  • EmblemHealth Preferred Plus Dental
  • EmblemHealth Dental Access Program

*Individual plans are not available.

Our Dental Networks

Our four dental networks consist of over 8,000 dentists and dental specialists practicing in New York and New Jersey. Participants meet a high credentialing standard and agree to treat covered patients at the fees detailed in our fee schedules.

Our dental networks are:

  • EmblemHealth Preferred Dental
  • EmblemHealth Preferred Plus Dental
  • EmblemHealth Dental Access Program*
  • Spectrum**

If patients contact your office asking whether you participate with EmblemHealth, please ask which plan they are insured with before stating your participation status. This will help smooth relationships with patients when it comes to billing for out-of-pocket expenses.

*You must participate in the Preferred network to also participate in the Dental Access Program network.
**You must participate in the Preferred network to also participate in the Spectrum network.

Our Preferred and Preferred Plus Networks
These networks are separate and unrelated and each has distinct patient enrollment and reimbursement schedules. You may join one or both networks — the choice is yours. Your participation in both networks may prove beneficial to your practice. Plus, when you join our Preferred network you automatically become a participant of our discounted Dental Access Program, allowing you to see and treat patients with Dental Access coverage.

Note: You may opt out of Dental Access.

Emblem Health Claim Address

Effective September 1, 2012, as part of our continuing effort to improve service to our providers, the following Kingston post office box addresses currently in use for GHI HMO and EmblemHealth Medicare PPO Customer Service and Grievance and Appeals will be closed.

*With the exception of the GHI HMO claims address, all NYC post office boxes may be used now.

Kingston Post Office Box Changes for GHI HMO Business and EmblemHealth Medicare PPO Effective September 1, 2012*

DepartmentExisting AddressNew Address
GHI HMO ClaimsPO Box 4141
Kingston, NY 12402
EmblemHealth
PO Box 2844
New York, NY 10116-2844
GHI HMO Grievance
and Appeals
PO Box 4443
Kingston, NY 12402
EmblemHealth
PO Box 2844
New York, NY 10116-2844
GHI HMO Customer ServicePO Box 4443
Kingston, NY 12402
EmblemHealth
Customer Service Interview Unit
55 Water Street, 1st Floor
New York, NY 10041-8190
Medical ReviewPO Box 4282
Kingston, NY 12402
EmblemHealth
55 Water Street, 12th Floor
New York, NY 10041-8190
Medicare PPO Customer ServicePO Box 4296
Kingston, NY 12402
EmblemHealth
PO Box 1701
New York, NY 10023
Grievance and Appeals
for Medicare PPO
PO Box 4296
Kingston, NY 12402
EmblemHealth
PO Box 2807
New York, NY 10116-2807

Emblem Health Advantage Care

New technology equips ACPNY clinical teams with the latest medical research and best practices in real time to save lives, improve care and reduce medical costs

NEW YORK (March 28, 2019) – EmblemHealth, one of the nation’s largest non-profit health insurers, and its partner, AdvantageCare Physicians (ACPNY), one of New York’s largest primary and specialty care practices, announced today they are joining forces with HealthReveal, a clinical AI company dedicated to curating and deploying the latest in scientific medical evidence to improve patient outcomes and quality of life. ACPNY has integrated HealthReveal’s clinical tool into its care model to improve patients’ health by harvesting the latest research-backed clinical recommendations that are actionable and personalized. HealthReveal’s technology was piloted in partnership with physician leaders at three ACPNY medical offices beginning in 2018 and will be deployed across all of ACPNY’s sites by May 2019.

ACPNY’s physicians made the decision to launch HealthReveal in all sites to ensure that their practice will be able to deploy the latest scientific research and best practices as they become available to improve care for patients with chronic disease before potentially catastrophic complications occur. This emphasis on proactive care is aligned with ACPNY’s team-based, coordinated approach to population health.

“ACPNY is an incubator for innovation,” said Karen Ignagni, President and CEO of EmblemHealth. “This initiative represents the next generation of population health, harvesting for care teams the latest science and best practices in real time.”

Today, HealthReveal’s technology is integrated into ACPNY’s Epic electronic medical record system. When HealthReveal detects an opportunity for an optimal course of treatment, it proactively issues a “Reveal” to clinicians with a personalized and precise recommendation. This enables clinicians and care teams to have the benefit of this information in real time and within their existing workflow, without the need for separate or additional applications.

For example, a Reveal was issued for a patient with atrial fibrillation and an elevated risk of stroke to consider pharmacological stroke prevention. The physician carefully reviewed the Reveal and took action by prescribing oral anticoagulation to the patient. Stroke risk can be reduced by 66 percent in properly anticoagulated patients.

“Our clinical approach starts with patient centered primary care,” says Dr. Navarra Rodriguez, President and Chief Medical Officer of ACPNY. “Our partnership with HealthReveal reflects our commitment to putting evidence-based care into practice.”

“HealthReveal’s goal is to help drive continuous, guideline-directed clinical care for all patients, and through this partnership with AdvantageCare Physicians and EmblemHealth, we are bringing personalized, clinically-effective care to thousands more New Yorkers,” said Dr. Lonny Reisman, founder and CEO of HealthReveal. “Our solution allows clinicians to offer personalized patient care backed by the latest medical research and insights, and allows health plans to support optimal care for members with chronic disease who are at risk for costly and catastrophic outcomes.”

Emblem Health Urgent Care Location

Where to Find One

When you need to see a doctor after office hours or on weekends for non-emergency care such as a sore throat or other minor health problems, visit one of our network urgent care centers for treatment. Where you go for care matters – know your treatment options.

Network Urgent Care Center Locations

Looking for an urgent care center? Sign in to our provider search tool or access as a visitor and select “Hospital, Facility or Urgent Care Center.”

Find an Urgent Care Center

No Referrals Needed for Urgent Care

Please note that no referrals are needed to visit a network urgent care center. We suggest you visit an urgent care center instead of an emergency room, when possible. Going to a network urgent care center will lower your copayments and cut your time waiting to be seen.

Of course, if you think you are having a medical emergency – when there is blood loss, unconsciousness or a threat to life – you should call 911 or go to the nearest emergency room. Please refer to your Member Handbook to better understand what an emergency is.

For additional information, please contact customer service.

Emblem Health Urgent Care Provider

NEW YORK—AdvantageCare Physicians (ACPNY), one of the largest primary and specialty care practices in the New York area, today announced a partnership with the City of New York to increase access and availability for COVID-19 testing. This follows a similar partnership announcement on Saturday, May 23rd between ACPNY and the State of New York by New York Governor Andrew Cuomo to expand testing.

New York State and the City of New York’s partnerships with AdvantageCare Physicians will establish more than 20 new testing sites at medical offices downstate, including testing centers in low-income and minority communities. Currently, New York has more than 760 testing sites across the state, according to the governor’s office.

During his press conference announcing the partnership, New York City Mayor Bill de Blasio said, “We have a new partnership to announce today,…AdvantageCare Physicians is stepping up, joining the fight and we are so thankful to them…Thank you to everyone at AdvantageCare, this is another great step forward making testing easier, making it more available and free.”

Through these partnerships, ACPNY will be able to open additional community testing sites, helping expand the City’s overall testing reach into hard-hit neighborhoods. ACPNY testing locations will be supplied with necessary personal protective equipment (PPE), testing kits, and increased lab capacity to accelerate testing and keep clinicians and patients safe.

EmblemHealth POS, Select Care, Select Value, and Essential network.

The Prime network includes providers in our service area of 28 counties in New York with Tristate access to all counties in Connecticut and New Jersey

The Select Care and Select Value plans come in different tiers.

Select Care plans can exist as catastrophic insurance, bronze, silver, gold, and platinum plans.

For more details on rates and coverage, view our updated [Emblem rates sheet. ]

The Select Care plans come at the bronze and silver tiers.

These plans have higher deductibles that are also out-of-pocket limits. They also come with vision and dental. Lastly, the Essential plan is for people who qualify based on income requirements.

Why as I broker, EmblemHealth is not my favorite.

EmblemHealth change plan, doctor networks all the time. Even I can barely keep up with them.

Emblem Small Group Plan Find a Doctor

Even on locating a doctor, Emblem doesn’t make it easy. [Click here] & pick your network.

If there update their website provider search link again, kindly [Click here] to notify us.

Emblem Review [BBB, Yelp]

Emblem Health has an A+ rating with the Better Business Bureau (BBB).

However, the BBB has been known in the past to give good reviews to companies with nothing but negative feedback. Emblem had 75 complaints filed against them in the past three years, 37 of which were closed in the past 12 months. For a company of this size, those numbers are rather low.

In 2014, in which the company was fined $300,000 due to its failure to disclose out-of-pocket costs for out-of-network care.

As a result, they agreed to disclose out-of-network fees. This action was taken against GHI, which was a part of Emblem at the time.

On Yelp, it has 114 reviews and only one star.

Most negative reviews seem to be about the difficulty in finding doctors near them that accept the insurance. It was so hard to find Emblem health care providers they actually reduced their provider network by 90% at the beginning of the year.

Emblem health went from offering all HIP providers to Emblem select care providers– drastically cutting the number of Emblem health hospitals.

There are 90,000 Emblem health care providers in New York alone. The Emblem provider network also includes 43,000 providers in Connecticut and New Jersey combined.

This huge network expansion is now making Emblem one of the most affordable health coverage options. you can find the details of the EmblemHealth provider network expansion below. To see how your provider network may improve, view the differences between the HIP Prime and Select Plans.

[The Really Great Part About EmblemHealth]

If you are a doctor. You might love their reimbursement. EmblemHealth, keep it up.

If you are an employee, I heard many good reviews internally & even on sites like #indeed &, etc.

If you are their user, there used to pay well & don’t short change their user on reimbursement, but

etc, click on image to see for yourself.

EmblemHealth Yelp Review

EmblemHealth Yelp Review

These are available for every plan

  • Urgent care and Generic Rx. Only Copays
  • FREE ACUPUNCTURE
  • GYM REIMBURSEMENT: $200 every six months. $100 for the spouse
  • FREE* DENTAL Exam and cleaning plus more, see attached
  • FREE* VISION Exam, lenses, and contacts cover by EmblemHealth at 80%, members pay just 20%
  • FREE* WELL WOMAN EXAMS / FREE Routine Gynecological / FREE
  • MAMMOGRAPHY SCREENING
  • FREE* Prenatal/Postnatal doctor visits
  • DEDUCTIBLE DOES NOT apply for PCP office visits, lab work
  • FREE Telemedicine.

Emblem HSA/HRA Plan

Administrative Fee Schedule for HealthEquity

Emblem Contact Phone Number

For any Billing or Account Services inquiries, it is best to call the tel. Found in the invoice: 212-615-4858

BROKER/GROUP SERVICES:

Tel. 866-614-6040

Email: brokerservices@EmblemHealth.com

FOR MEMBERS, they should contact the number on the back of their ID cards, see below:

EmblemHealth Customer Service 800-447-8255, or www.emblemhealth.com and click REGISTER

Is EmblemHealth Right for You?

If you are looking to buy health insurance, it’s important to compare all your options. First, be sure to view our chart of group health insurance rates. Or, simply fill out a quick form and get an instant health insurance quote online. If you need some help to find the right plan for you, give us a call at 212-484-9888.

Get Reimbursed for Getting Fit – EmblemHealth

As an EmblemHealth Qualified Health Plan or Essential Plan member, you can get paid back – in full or in part — for your health club membership fees. … Join or be a member of a participating health club or fitness center (not tennis clubs, weight-loss clinics or spas) AND.
www.emblemhealth.com › gym

Emblem Pay Bills Online

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Log on to emblemhealth.com and scroll to the bottom of the page. Under the employer tab select sign in.

Click on the register tab below.

Complete the requested information below and click Validate.

You need the Last Invoice Number:

When you finish the above step, you need to fill up the required information

Registration Success. Then you will receive an e-mail by Emblem to login

After registration, you can log in to set up auto pay

Click “Pay My Bill”

And then click the group name

Allow popup before you click “Set up Auto-Pay”

Then fill up the information as request

Doule check your information, then click Confirm

You can print out the confirmation to keep a record

 

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