The mission of EmblemHealth Neighborhood Care is to reinforce a holistic approach to health and wellness and help health plan and community members take a more active role in their mental and physical well-being. EmblemHealth Neighborhood Care offers our plan members and other community members a place to go to get the personalized, one-on-one support of experts in clinical, benefits and health management solutions. Neighborhood Care does not provide medical services. Instead, our role is to help practitioners manage patient care by supporting the primary practitioner-patient relationship.
Using the EmblemHealth Neighborhood Care Provider Recommendation Form, providers can recommend that a plan member visit a local Neighborhood Care site for the services listed below (see the forms at the end of this chapter and at emblemhealth.com):
- In-person EmblemHealth customer service (billing, claims)
- Health plan navigation
- Care management and coordination (for EmblemHealth plan members)
- Assistance with DME fulfillment
- Health and wellness resources
- Fitness and wellness classes
- Health care education
- Behavioral health care
- Medication support
- Disease and condition self-management
The Neighborhood Care team of professionals consists of:
- Site Managers: Site managers oversee the staff and operations of the site and also function as customer care navigators to help make appropriate connections for customers. They also work with community partners and care providers to develop health and educational programming relevant to the site to address the needs specific to the community.
- Customer Care Navigators: Customer Care Navigators help connect EmblemHealth members to health and wellness services, care coordination and customer service, and community resources. They also make warm connections to sales partners to help visitors determine their eligibility for health care, choose a health plan and complete health plan enrollment.
- Social Workers: Certified Social Workers assist members with matters such as housing, financial assistance, education and career guidance and specialized health services. They also help make connections to community resources.
Neighborhood Care locations:
EmblemHealth Neighborhood Care — Harlem (AdvantageCare Physicians next door)
215 W 125 Street | 866-469-0999
EmblemHealth Neighborhood Care — Chinatown
87 Bowery | 855-283-2151
EmblemHealth Neighborhood Care at AdvantageCare Physicians Express
52 Duane Street 212-423-3901
EmblemHealth Neighborhood Care — Cambria Heights (AdvantageCare Physicians next door)
206-20 Linden Blvd | 866-539-0999
EmblemHealth Neighborhood Care at AdvantageCare Physicians Flushing Medical Office
140-15 Sanford Ave Suite A, Area G | 800-447-0752
EmblemHealth Neighborhood Care — Crown Heights (AdvantageCare Physicians next door)
546 Eastern Parkway | 855-283-2156
EmblemHealth Neighborhood Care at AdvantageCare Physicians Brooklyn Heights Medical Office
195 Montague Street, Floor 2 | 212-423-3901
EmblemHealth Neighborhood Care — Bensonhurst at EmblemHealth sales office
2482 86th Street | 800-447-0856
Visit the EmblemHealth Neighborhood Care website at emblemhealth.com/community for more details.
Glossary terms found on this page:
Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.
Services available to a member as defined in his or her contract. Benefit design includes the types of benefits offered, limits (e.g., number of visits, percentage paid or dollar maximums applied) and subscriber responsibility (cost sharing components).
An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.
Medical equipment, goods, implements and prosthetics that are prescribed for patient care, usually in an outpatient setting. Examples of such equipment include hospital beds, wheelchairs and walkers.
A determination of whether or not a person meets the requirements to participate in the plan and receive coverage under the plan.
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.
An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.
A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.
A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:
- Doctor of medicine
- Doctor of osteopathy
- Doctor of podiatric medicine
- Physical therapist
- Nurse midwife
- Certified and registered psychologist
- Certified and qualified social worker
- Nurse anesthetist
- Speech-language pathologist
- Clinical laboratory
- Screening center
- General hospital
- Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes
A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.