Come Take a Look!

Member Satisfaction

Utilization Review Criteria Update

Medical Director Availability After an Adverse Determination

EmblemHealth Neighborhood Care Success Stories

EmblemHealth Introduces National Diabetes Prevention Program

Appointment Availability and Access Surveys

Claims Corner

Submit Claims with Accurate Pay To Information

CareCore Manages Accreditation and Privileging for SRPP

Changes to Look Back Period for Medicare

Behind the Scenes

Help Your Patients Understand

Member Rights and Responsibilities

Correctly Coding HIV Care

Healthy Beginnings PATH Updates

Healthy Discounts for Members

EmblemHealth Resources for Managing Your Patients With HIV/AIDS

Brochure for Teens Now Available!

Low Dose Aspirin Therapy

Managing and Treating LDL Levels

Dental Hygiene Is Important

Clinical Corner

News&Notes Archive


EmblemHealth Neighborhood Care
Success Stories

EmblemHealth Neighborhood Care is meeting the needs of residents in both Harlem and Cambria Heights, Queens. Every day more people in these neighborhoods become aware of the services available through Neighborhood Care. While we can provide information and education to everyone in the community, we offer expanded clinical services to those who are EmblemHealth members.

Two examples of recent success with members are highlighted below:

At the Harlem Neighborhood Care location, a member came in complaining of increasing leg pain. The Health Care Solutions Specialist worked with the member's physician to increase his pain medications and ensured that the member kept appointments with his PCP and a neurologist.

The member's lack of mobility and a recent fall resulted in greater dependency on his family. The solutions specialist initiated an application for Access-a-Ride for transportation to and from his medical appointments. The solutions specialist also arranged for a walker to help his balance and to prevent falls. The walker arrived at his home the very next day!

The solutions specialist worked with the memberís PCP to coordinate physical therapy and additional testing and then met with the PCP, the member and his daughter to review and explain the results. The PCP recommended referral to a urologist and the solutions specialist helped the member find one. The member was also referred to our managed long-term care program.

Within days, the member was walking better with his walker and was able to stand without assistance. We continue to monitor this memberís progress.

In Cambria Heights, Queens, a member's spouse came in extremely upset that his wife had not been approved for a motorized scooter. The motorized scooter was denied in March 2012 for lack of medical necessity. The manís wife has diabetes and diabetic neuropathy, resulting in numerous falls. Because of absences from work related to his wifeís illness, the husband had recently lost his job.

The couple was informed of their right to appeal the decision by following the directions in the Adverse Determination letter. The solutions specialist also worked with the member's physician to ensure the doctor understood the medical documentation needed to ensure the member was approved for a motorized scooter.

The solutions specialist referred the member to our Complex Case Management program to obtain personal care services to ensure the member is no longer at home alone and her husband can focus on finding work. The solutions specialist also referred the member to our Steps-4-Safety PATH fall prevention program.

We invite practitioners to visit our Harlem and Cambria Heights locations or take a virtual tour. See how we can help your patients follow your plan of care and better manage their health. We can also answer their health insurance questions and help them navigate the health care system. Go to our Neighborhood Care Web site for additional information on services, programs and events at each location.


  Printer Friendly Page