NYC Medicaid Provider Guidance

February 22, 2014 6:30 AM

I can't choose my choice if I don't know what I'm choosing. Can any Mefites provide pros, cons, doctor or nurse names, locale convenience, or any other information or opinions on various healthcare providers in NYC? I was recently awarded New York State of Health full coverage (i.e. Medicaid) due to unemployment. Now I've got to choose a plan, but I have no idea which plan to choose.

I'm new to NYC and I've never heard of any of the provider choices New York State of Health is offering, nor does anyone I know have any insight. Moreover, health providers appear to work radically differently in New York City, compared to Greater Boston where I lived for some years. Or at least I think they do: In Boston, I had a local clinic, linked to a community hospital for extras, and a major hospital for specialists. It was wonderful. Can anyone describe how it works in Manhattan?

As to my core question, my provider ideal is everybody's ideal: warm, friendly, efficient, well-trained, prevention-oriented health providers, with, preferably, reasonably short wait times. If I can't have that, I'll take the next best thing, whatever it is. So, Mefites, any opinions pro or con on these providers?

Note: If it helps, I'm located on the Lower East Side.

Here's the list:

Healthplus, An Amerigroup Company
Emblem Health
Healthfirst PHSP
MetroPlus Health Plan
Fidelis Care
Affinity Health Plan
United Health Care Community Plan
WellCare

posted by anonymous to Health & Fitness (9 answers total)

I'm not familiar with any of these plans, but you should be able to look at their provider networks on their web sites and see if your doctor is included (or doctors in your area). If their web sites aren't yet up to date, you can call their member services lines and they will be able to tell you if they have your doctor or what clinics/hospitals are available in your area.

In terms of pros and cons of health plans, all state Medicaid health plans are legally required to offer you the exact same Medicaid benefits. They'll differ in three areas only:

1) Provider networks - this is the most important. Make sure your provider is in the network of the plan you choose, by calling or visiting the web site. Or make sure there are providers near you if you don't have one. If you don't select a primary care provider, chances are they'll assign one to you.

2) Customer service - this is harder to quantify. You can check Yelp and look for reviews, but generally only time will tell. If you choose a plan that turns out to have shitty customer service, you can choose a different plan at any time, and it the change will be effective quickly - usually by the first day of the following month if you make the change by the 24th or so.

3) "Extra" benefits. Look at their pages for prospective members (often titled "Need Insurance?" or something similar) and see what's listed there. Sometimes plans will offer things like reimbursements for fitness or weight watchers, cash back for seeing your PCP for an annual visit, stuff like that. Pick what you like best.

I can't help with how providers actually work in Manhattan, but in general, Medicaid is Medicaid, and when a provider signs with a health plan to be in their network, generally that provider's whole clinic also signs. The clinic SHOULD be affiliated with a hospital. You might try checking for your local hospital on each health plan's web site, and then calling that hospital to see what clinics are affiliated with it.
posted by kythuen at 7:35 AM on February 22, 2014

I had HealthPlus when I had Medicaid. It was fine: everything was covered 100% as long as I went to a place that took Medicaid. But I never actually had to call them for anything because, again, I never got a bill and no one ever questioned my coverage. I just had to make sure they took Medicaid and I was good.
posted by griphus at 9:06 AM on February 22, 2014

(Just to be clear: you can show up to any doctor or any clinic you want; as long as they take Medicaid, they'll take you and you don't have to pay. Or, at least, that was my experience and I end up at the doctor more often than the average person.)
posted by griphus at 9:07 AM on February 22, 2014

Ugh, sorry, don't mean to spam your question: I just remembered I had to pick a Primary Care Physician (PCP) from their list, and the list was pretty extensive. If you already have a doctor who takes insurance, there's a good chance they'll take whatever you get on.

As far as dentists (take advantage of the free dental care!!!), clinics, facilities and stuff goes, if you have to pick one yourself, find out who takes Medicaid, call them up and just make sure they take yours just in case. If they do, that's it, you're good. You show up, give them your card, they do their thing and that's that. Otherwise, if your PCP is referring you to someone, just ask them to make sure they take Medicaid.

You're not going to end up at the best and nicest doctors on Medicaid, but you're also never going to have to pay for anything as long as you make sure they take your insurance wherever it is you go. Medicaid is, in many ways, much, much better than any private insurance you can get because there's few necessary things it doesn't cover -- you'll have a hard time w/ mental health services, unfortunately -- and anything it covers, it covers in full.
posted by griphus at 9:15 AM on February 22, 2014

Followup from the anon OP:

I appreciate everyone's reply thus far, and hope people keep responding! But I just wanted to clarify that I have *no* providers in NYC now, as I just recently moved here. So one major purpose of the question is to help facilitate finding a *good* provider.

On a related note, I do still have a specialist in another state I'd like to continue seeing, and I'd be interested to know if anyone knows whether New York State of Health will pay for me to see an out-of-state specialist. Does anyone have any knowledge of this?

Many thanks

posted by LobsterMitten at 10:17 AM on February 22, 2014

Regarding Fidelis Care: If you have lady-parts, you should be aware that "Fidelis Care does not cover certain family planning and reproductive health services, such as abortion, sterilization, and prescription birth control." (from page 8 of their handbook .pdf) However, they state that you would still be able to get those services, but you would have to use your Medicare card, not your Fidelis Care card.
posted by Maladroid at 10:23 AM on February 22, 2014

Generally Medicaid programs will not pay for out-of-state office visits, just emergency hospital care.
posted by ThePinkSuperhero at 10:26 AM on February 22, 2014

The big issue is what's going to be in-network for the hospital system that's most convenient for you, since most of the hospitals have lots of affiliated primary care and a full network of sub specialists.

For example, Metroplus is the plan of the city's public hospitals and is not accepted by most of the others.

Fidelis is Catholic-affiliated in some way and there is some kind of process needed to get abortion services, contraception or sterilization.

NYU is in-network for Fidelis, Affinity, and United.

NYP is in-network for United, Emblem, and Aetna.

Beth Israel/Mt Sinai is in network for
six of the nine plans but I'm not sure which ones.
posted by The Elusive Architeuthis at 6:35 PM on February 22, 2014

1. Find a list of providers on the company site. (I have UHC which is totally fine and picked my doctor based on them being in a big practice and being nearby.)
2. Look them up on ZocDoc. Decent reviews? Cool. Make an appointment.
posted by Potomac Avenue at 9:22 PM on February 22, 2014