Billing Information for NYSHIP—The Empire Plan
We understand that medical billing can be complex and hard to understand. That’s why we’ve created this page to help explain the process and provide answers to common questions, all with the goal of making your life a little simpler and easier.
Key points
- NYSHIP is New York State’s Insurance Program
- The Empire Plan let’s you choose any doctor, even if they are out-of-network
- NYSHIP works with Beacon Health, Carelon, and United Healthcare to help cover your medical expenses
- If your insurance company sends you a check to cover your bills, you can use a credit card to pay them
What is NYSHIP…The Empire Plan?
NYSHIP stands for the New York State Health Insurance Program. Just like other insurance companies, NYSHIP has different plans you can choose from and The Empire Plan is one of the best plans they offer.
Companies that help NYSHIP Administer The Empire Plan
When you go to the doctor and they bill your insurance, NYSHIP works with other companies to help pay that bill. These companies, like United Healthcare, Beacon Health, or Carelon, will take care of the payment and send you a statement showing what they paid. Sometimes, they pay the doctor directly, but other times they send the payment to you.
If you receive a check in the mail, it means the company has sent you that money to pay the doctor. It’s important that you use that money to pay the doctor, so you’re responsible for doing that.
Paying the Doctor If You Receive a Check in the Mail
Usually, when people receive a check in the mail, they pay their doctor using a credit card. It usually takes about a week for the check to arrive and be deposited into your bank account. But as a courtesy, we wait three weeks before charging your credit card, just to give you some extra time.
Normally, we charge your credit card to make the payment because it’s easier for you. You don’t have to do much work. However, if it’s more convenient for you, you can take a picture of the front and back of the check and email it to us. Just remember to tell us beforehand that you want to do this. We will then deposit the money electronically, so you don’t have to make a trip to the bank.
Frequently Asked Questions
Do you accept NYSHIP
If you have NYSHIP—The Empire Plan, you have the freedom to choose any healthcare provider, even if they are not in the network. This is why we accept NYSHIP as an out-of-network provider. It means that we will send the bills directly to NYSHIP on your behalf, and they will pay us. However, similar to when you see in-network providers under NYSHIP, there might be a co-insurance or a deductible that you will need to pay.
Why did I receive a statement from a name I don't recognize...such as Beacon Health Options, Carelon or United Healthcare?
The Empire Plan NYSHIP works with organizations like United Health Care, Carelon and Beacon Health Options to help them pay medical bills. These companies receive, manage and administer medical bills and send out statements and explanations of benefits. Whether Beacon, United or some other company pays the medical bill depends on many factors such as your medical history. Since different organizations assist NYSHIP with paying medical bills, one of the things a company like United Healthcare does when it reviews a bill is makingt sure that they are the right company to pay it based on the specific circumstances of your visit.
Because of this, you might get mail from Beacon Health Options, Carelon, United or some other company and not recognize the name. We understand that this can be confusing. But don’t worry, this is a normal part of the billing process that NYSHIP follows. Whether you get a bill from United, Beacon or some other organization it just means they are responsible for helping pay your bill based on different rules that NYSHIP has established.
Our main goal is to make sure your claims are processed correctly and paid according to the rules. We understand that this may be confusing but we want to assure you that the billing process follows specific rules and guidelines. If you have any more questions or need help understanding, please don’t hesitate to contact us. We are here to assist you and give you the support you need.
Telehealth Office Visits
Telemedicine visits are just like regular visits to the doctor’s office. According to the Centers for Medicare & Medicaid Services as well as the State of New York, the visits are considered the same as in-person visits and are billed and reimbursed in a simliar fashion.
Why is the billed amount so high?
When you see a doctor, you will receive a statement called an explanation of benefits that, technically speaking, is not a bill, but it will usually show a “billed” amount. Thus amount is usually a lot higher than an insurance company pays. There are many different explanations provided for why bills are what they are but we try our best to keep these amount similar to those suggested by the non-profit FairHealthConsumer.org. We realize that many individuals have had a poor experience in the past with companies that have acted aggressively to collect medical bills, which is why we try are best to ensure that we stay far away from such behaviors. We value maintaining a relationship with our patients that encourages patients to see the doctor based on their health needs, not their financial availability.
When you visit a doctor, you’ll get receive an explanation of benefits from your insurance. It’s not exactly a bill, but it does shows how much the doctor charged for their services. This amount is usually higher than what your insurance company pays. There are different reasons for why bills are the way they are, but we do our best to keep them similar to what a non-profit organization called FairHealthConsumer.org suggests. We understand that some people have had bad experiences with companies that aggressively collect medical bills. That’s why we make sure we stay far away from that kind of behavior. We believe in building a relationship with our patients that allows them to see the doctor based on their health needs, not just how much money they have available to pay for healthcare.
What if I can't afford to pay
We want patients to feel comfortable telling us if they got a bill they can’t afford. We know that some people might feel embarrassed or think it’s their fault if they have medical debt. But we understand that medical expenses have gotten really expensive lately. That’s why we work closely with patients to make sure they don’t end up with medical debt they can’t pay.
When someone can’t pay their medical bills, we have more flexibility than big organizations. They might send the debt to collection agencies or take legal action, which can hurt a person’s credit. We believe that your health should determine your access to care, not how much money you have. That’s why we have policies that are friendly to patients.
DISCLAIMER:
The preceding article is intended solely for informational purposes and does not constitute legal advice, reflect any qualified legal opinion, or guarantee any benefits, billing, authorization, or eligibility. All benefit payments are contingent upon the terms, conditions, limitations, and exclusions outlined in the agreements between you and your insurance provider, Morgenstern Medical, your employer, or any other relevant entity.
Every effort has been made to present complex subjects accurately, concisely, and in a comprehensible manner. However, certain words, terms, or phrases used in this article may be susceptible to misinterpretation or may carry different meanings than intended. For instance, we may employ the phrase “receive a bill” interchangeably with “receiving an explanation of benefits” (EOB). This linguistic choice is aimed at simplifying and elucidating the information provided, notwithstanding the possibility of technical inaccuracies or omissions. In the given example, it should be noted that the individual has technically received an EOB indicating a billed amount, rather than an actual bill.
While we have relied upon meticulously researched and authoritative articles to compose this piece, it is important to acknowledge that our sources are occasionally subject to similar limitations and may be susceptible to varying interpretations of the law, rules, and regulations.