Provider Network

Provider Coverage: In and Out of Network

If you want out-of-network coverage while keeping in-network copays low, choose the GHI CBP plan.

With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.

With the GHI CBP plan, you never need a referral to see network doctors. In addition to our network doctors, you can get covered care from any doctor you choose, offering you the widest possible choice.

Covered services from out-of-network doctors do, however, have deductibles and coinsurance. Covered services from out-of-network doctors do, however, have deductibles and coinsurance. Payment for services provided by out-of-network providers is made directly to you under the NYC Non-Participating Provider Schedule of Allowable Charges (Schedule). The reimbursement rates in the Schedule are not related to usual and customary rates or to what the provider may charge but are set at a fixed amount based on GHI’s 1983 reimbursement rates. Most of the reimbursement rates have not increased since that time, and will likely be less (and in many instances substantially less) than the fee charged by the out-of-network provider. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement; therefore, you may have a substantial out-of-pocket expense.

If you intend to use an out-of-network provider, you can obtain an estimate of the out-of-network, reimbursement rate for the anticipated medical procedure by utilizing GHI’s CBP Allowance Calculator, which is available online in the GHI-CBP members’ secure section at www.emblemhealth.com, or by calling GHI Member Services at 1-800-624-2414. Prior to utilizing the CBP Allowance Calculator or calling Member Services, you must obtain from the out-of-network provider the medical procedure code(s) (CPT Codes) of the service(s) you anticipate receiving. Also note that some services may require prior approval.

The best way to make use of GHI CBP and save on your out-of-pocket costs is to see a doctor within the network. Your out-of-pocket costs are lowest — in most cases, just a copay — when you see network doctors.

Your Protections for Out-of-Network Emergency Services and Surprise Bills

The Right Care, Right in Your Neighborhood

Finding a doctor you trust and respect can be a painful process. And when your spouse and your child have come down with something, spending the day traveling all over town to see different doctors only adds to the stress. Having a medical practice near your home that has physicians, specialists and pediatricians under one roof can help you get the care you need without the hassle.

AdvantageCare Physicians understands these concerns and has built a practice designed to meet these unique needs. They are the newest addition to the EmblemHealth family and are now one of the largest physician-led practices in New York City.

With 35 locations throughout New York City and Long Island, you can find a convenient location near home or work. AdvantageCare Physicians’ medical offices include primary care doctors and specialists. Some medical offices also have additional services like EmblemHealth pharmacies, an on-site lab, urgent care and extended hours. And their electronic health records system ensures your medical history is available at any location.

Services for City of New York Employees

As a City of New York employee with a GHI or HIP plan, you have exclusive access to a dedicated Gold Service Line — 1-646-680-3000. At this number, you can access the AdvantageCare Physicians network to get more information, schedule appointments and get connected to EmblemHealth to answer any questions about your plan.

You and your family will benefit from:

• Urgent care or extended hours in most locations
• Highest quality ranking in NYC
• Team-based care — ensures better health outcomes
• Full range of health services — primary care, pediatrics, cardiology, OB/GYN, GI, laboratory, pharmacy, X-ray and more
• Coordinated care across 36 locations with electronic health records that allows your information to travel with you to all locations

To learn more about the AdvantageCare Physicians difference, call the dedicated City of New York Employee Gold Service Line at 1-646-680-3000 or visit www.acpny.com/city.