How do I Find Out If a Procedure Is Covered by an Empire BlueCross/BlueShield Policy?

Empire BlueCross BlueShield offers New York residents a choice from among many managed-care plans. The company's home page reflects the many choices by offering 18 links to information that might be of interest to their consumers. For a consumer who needs a specific surgery or other medical procedure, finding out whether it is covered can be a bit confusing. Although group health plan specifics are not available directly from the website, individual plan benefits are.

Instructions

• 1

  Go to the Empire BlueCross BlueShield visitor home page. Click on the light blue tab under the page header titled, "Individuals/Families." This will open the Individual Health Plans page, which will list five plans available to individual members.

• 2

  Click on any health plan to see an overview of each plan. The page for each plan discusses eligibility, benefits, enrollment, application costs and premium rates.

• 3

  Scroll down to the last bullet under the "Benefits" subhead on any of the following plan pages, "Direct Pay HMO/POS," "Direct Pay HMO," or "Healthy New York." The last bullets will offer a link to a complete benefit listing including all covered services and procedures. On the "TraditionPLUS Hospital Plan" page, a complete list of covered services can be accessed from the second bullet under the "Additional Information" subhead.

• 4

  Call 877-690-2766 to obtain information on covered services for group health plan members. Group health plans are purchased by employers, and policy booklets are distributed at work sites.

  Coverages by plans for health management organizations, or HMOs, and preferred provider organizations, or PPOs, are the same for group health plan members as they are for individuals. Point-of-service, or POS, plans extend coverage areas so traveling employees may receive covered health care from out-of-network providers.