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 for the Cambria Heights or Harlem locations, 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 www.emblemhealth.com ):
- Health and wellness resources
- Health care education
- Behavioral health care
- Medication support
- Disease self-management
- Health plan navigation
- EmblemHealth insurance selection assistance
- Care management (for EmblemHealth plan members)
The Neighborhood Care team of professionals consists of:
- Clinical support team: A registered nurse, pharmacist and program specialist are available to provide information and answers about medical issues, medications, prescriptions and prescription management. They also help visitors get home care and DME and find programs for managing their medical conditions.
- Health care solutions specialists: These staff help visitors determine their eligibility for health care, choose a health plan and enroll in a plan. They also connect people to community resources, customer service and benefits specialists.
- Community liaisons: They assist visitors in accessing local and government programs. They also organize community-based events and forums, develop curricula and cultivate partnerships.
Visit the EmblemHealth Neighborhood Care Web site at www.ehnc.com for a virtual tour and 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).
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 written order or refill notice issued by a licensed medical professional for drugs available only through a pharmacy.
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.