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raspbrryswl
LIF Infant
Member since 7/10 248 total posts
Name:
Jen
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Health Insurance Provider help
Hello! I need to choose a new health care provider and plan for my children. I am wondering if anyone is familiar with any of these? Your input on them would be greatly appreciated! TIA
1. Healthfirst
2. HealthPlus-American Group Company
3. Fidelis
4. Affinity Health Plan
5. United Healthcare Community Plan
6. Emblem Health
I used to have GHI, which is now Emblem Health but I see they have the worst ratings on the Market Place?! I'm on childcare leave and COBRA is way too much money to continue. =(
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Posted 5/13/15 12:31 PM  |
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ElizaRags35
My 2 Girls
Member since 2/09 20494 total posts
Name:
Me
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Health Insurance Provider help
It's hard to say because even if someone uses one of those insurance companies, their plan can be totally different from the one you'd be getting.
I had emblemhealth through my employer before they switched to Oxford and I loved it because I had no copays and never had an issue.
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| Posted 5/13/15 12:33 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Health Insurance Provider help
there are pluses and minuses of each one.... I guess it really depends on what you want, do you want less $ out of pocket, or better ease of finding a doctor? None of them have a large pool of physicians and facilities that accept them.
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| Posted 5/13/15 12:36 PM |
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mrsm-2011
He is my world!
Member since 6/12 3009 total posts
Name:
Theresa
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Re: Health Insurance Provider help
Do not choose Fidelis. I have this now (in the process of changing). My DS pediatrician said that 90% of specialists dropped fidelis, which is forcing her to eventually stop taking it.
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| Posted 5/13/15 12:41 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Health Insurance Provider help
Posted by mrsm-2011
Do not choose Fidelis. I have this now (in the process of changing). My DS pediatrician said that 90% of specialists dropped fidelis, which is forcing her to eventually stop taking it.
All of those options are being dropped. I actually don't hate Fidelis, from a practice management standpoint. We are not in network, but we have to see their patients in the hospital sometimes, and they pay pretty decently. Though, that's for in the hospital, in an office visit setting, they might pay crap (like all of the options). That's the biggest reason doctors have to drop them. It might be hard to imagine, but doctors simply cannot afford to accept these low-paying plans. Especially if they are in private practice.
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| Posted 5/13/15 12:45 PM |
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2boys1girl
and one more girl on the way!
Member since 5/10 2954 total posts
Name:
D
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Health Insurance Provider help
My kids have Fidelis for a few years now and we have no problem what so ever finding specialists.
I actually love it because it is one of the few insurances where there is NO referral needed from your primary to even see a specialist.
I took them off of the United Healthcare plan because Stonybrook no longer participates with them which took away alot of pediatric specialists in certain areas...also I believe PM Pediatrics didn't accept them anymore either which was an issue because I liked having that option.
ETA: IT was Fidelis PM didnt take...3 kids and 3 insurances later my head spins sometimes lol.
I have used Emblem Health for them and I currently have it and have had no issues what so ever for the past 3 years.
Message edited 5/13/2015 1:33:11 PM.
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| Posted 5/13/15 12:49 PM |
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mrsm-2011
He is my world!
Member since 6/12 3009 total posts
Name:
Theresa
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Re: Health Insurance Provider help
Posted by jessnbrian
Posted by mrsm-2011
Do not choose Fidelis. I have this now (in the process of changing). My DS pediatrician said that 90% of specialists dropped fidelis, which is forcing her to eventually stop taking it.
All of those options are being dropped. I actually don't hate Fidelis, from a practice management standpoint. We are not in network, but we have to see their patients in the hospital sometimes, and they pay pretty decently. Though, that's for in the hospital, in an office visit setting, they might pay crap (like all of the options). That's the biggest reason doctors have to drop them. It might be hard to imagine, but doctors simply cannot afford to accept these low-paying plans. Especially if they are in private practice.
Yeah, I totally understand that.
DS doctor actually took me aside and showed me that for some of the visits they were paying $0 and these are just regular monthly visits and an occasional sick visit. She told me that she wouldn't charge me, but that it is like pulling teeth to get a payment from them.
As of June 1 DS will have the United Healthcare Community Plan. Which is what his ped recommended.
Message edited 5/13/2015 12:56:42 PM.
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| Posted 5/13/15 12:55 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Health Insurance Provider help
Posted by 2boys1girl
My kids have Fidelis for a few years now and we have no problem what so ever finding specialists.
I actually love it because it is one of the few insurances where there is NO referral needed from your primary to even see a specialist.
I took them off of the United Healthcare plan because Stonybrook no longer participates with them which took away alot of pediatric specialists in certain areas...also I believe PM Pediatrics didn't accept them anymore either which was an issue because I liked having that option.
I have used Emblem Health for them and I currently have it and have had no issues what so ever for the past 3 years.
You're very lucky. Also, when did they stop requiring referrals from the Primary, because they used to require a referral/precert for EVERYTHING.
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| Posted 5/13/15 12:56 PM |
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NervousNell
Just another chapter in life..
Member since 11/09 54917 total posts
Name:
..being a mommy and being a wife!
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Re: Health Insurance Provider help
The thing is, it all depends on what plan you are on.
I have Emblem (which was GHI) and we have amazing coverage. But that is because we are on the NYPD plan which is very good.
Other people i know who have the same insurance company have different coverage, different deductibles etc.
It's very individual to the employer/plan rather than the insurance company themselves.
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| Posted 5/13/15 12:57 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Health Insurance Provider help
Posted by NervousNell
The thing is, it all depends on what plan you are on.
I have Emblem (which was GHI) and we have amazing coverage. But that is because we are on the NYPD plan which is very good.
Other people i know who have the same insurance company have different coverage, different deductibles etc.
It's very individual to the employer/plan rather than the insurance company themselves.
NYPD has a very specific contract with Emblem and the physicians - there are physicians that are only in the NYPD emblem network and NOT with the rest... but that is the except. The rest of the plans listed really don't have variances between plans within them, even Emblem. These are actually very specific plans, totally different from regular commercial plans.
Message edited 5/13/2015 1:01:18 PM.
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| Posted 5/13/15 1:00 PM |
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2boys1girl
and one more girl on the way!
Member since 5/10 2954 total posts
Name:
D
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Re: Health Insurance Provider help
Posted by jessnbrian
Posted by 2boys1girl
My kids have Fidelis for a few years now and we have no problem what so ever finding specialists.
I actually love it because it is one of the few insurances where there is NO referral needed from your primary to even see a specialist.
I took them off of the United Healthcare plan because Stonybrook no longer participates with them which took away alot of pediatric specialists in certain areas...also I believe PM Pediatrics didn't accept them anymore either which was an issue because I liked having that option.
I have used Emblem Health for them and I currently have it and have had no issues what so ever for the past 3 years.
You're very lucky. Also, when did they stop requiring referrals from the Primary, because they used to require a referral/precert for EVERYTHING.
It could possibly be just through NYS Health but it has been that way for us for almost 2 years...that I have needed.
From the website- "Fidelis Care products offered through the NY State of Health give members the freedom to see any doctor in the Fidelis Care network--no referrals required."
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| Posted 5/13/15 1:07 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Health Insurance Provider help
Posted by 2boys1girl
Posted by jessnbrian
Posted by 2boys1girl
My kids have Fidelis for a few years now and we have no problem what so ever finding specialists.
I actually love it because it is one of the few insurances where there is NO referral needed from your primary to even see a specialist.
I took them off of the United Healthcare plan because Stonybrook no longer participates with them which took away alot of pediatric specialists in certain areas...also I believe PM Pediatrics didn't accept them anymore either which was an issue because I liked having that option.
I have used Emblem Health for them and I currently have it and have had no issues what so ever for the past 3 years.
You're very lucky. Also, when did they stop requiring referrals from the Primary, because they used to require a referral/precert for EVERYTHING.
It could possibly be just through NYS Health but it has been that way for us for almost 2 years...that I have needed.
From the website- "Fidelis Care products offered through the NY State of Health give members the freedom to see any doctor in the Fidelis Care network--no referrals required."
I haven't worked with Fidelis in about 5 years, so that's awesome to hear.
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| Posted 5/13/15 1:13 PM |
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2boys1girl
and one more girl on the way!
Member since 5/10 2954 total posts
Name:
D
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Re: Health Insurance Provider help
Posted by jessnbrian
Posted by 2boys1girl
Posted by jessnbrian
Posted by 2boys1girl
My kids have Fidelis for a few years now and we have no problem what so ever finding specialists.
I actually love it because it is one of the few insurances where there is NO referral needed from your primary to even see a specialist.
I took them off of the United Healthcare plan because Stonybrook no longer participates with them which took away alot of pediatric specialists in certain areas...also I believe PM Pediatrics didn't accept them anymore either which was an issue because I liked having that option.
I have used Emblem Health for them and I currently have it and have had no issues what so ever for the past 3 years.
You're very lucky. Also, when did they stop requiring referrals from the Primary, because they used to require a referral/precert for EVERYTHING.
It could possibly be just through NYS Health but it has been that way for us for almost 2 years...that I have needed.
From the website- "Fidelis Care products offered through the NY State of Health give members the freedom to see any doctor in the Fidelis Care network--no referrals required."
I haven't worked with Fidelis in about 5 years, so that's awesome to hear.
It definitely is with kids cause lord knows how many times you need to see some sort of pediatric specialist to check on things.
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| Posted 5/13/15 1:21 PM |
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BargainMama
LIF Adult
Member since 5/09 15657 total posts
Name:
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Re: Health Insurance Provider help
Posted by 2boys1girl
My kids have Fidelis for a few years now and we have no problem what so ever finding specialists.
I actually love it because it is one of the few insurances where there is NO referral needed from your primary to even see a specialist.
I took them off of the United Healthcare plan because Stonybrook no longer participates with them which took away alot of pediatric specialists in certain areas...also I believe PM Pediatrics didn't accept them anymore either which was an issue because I liked having that option.
I have used Emblem Health for them and I currently have it and have had no issues what so ever for the past 3 years.
I have Fidelis and Stony Brook doesn't accept it. Or at least it didn't when I chose the plan. Has that changed?
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| Posted 5/13/15 1:28 PM |
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2boys1girl
and one more girl on the way!
Member since 5/10 2954 total posts
Name:
D
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Re: Health Insurance Provider help
Posted by BargainMama
Posted by 2boys1girl
My kids have Fidelis for a few years now and we have no problem what so ever finding specialists.
I actually love it because it is one of the few insurances where there is NO referral needed from your primary to even see a specialist.
I took them off of the United Healthcare plan because Stonybrook no longer participates with them which took away alot of pediatric specialists in certain areas...also I believe PM Pediatrics didn't accept them anymore either which was an issue because I liked having that option.
I have used Emblem Health for them and I currently have it and have had no issues what so ever for the past 3 years.
I have Fidelis and Stony Brook doesn't accept it. Or at least it didn't when I chose the plan. Has that changed?
They do, but I was backwards in my previous post PM Pediatrics takes Emblem and United but not Fidelis.
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| Posted 5/13/15 1:32 PM |
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NervousNell
Just another chapter in life..
Member since 11/09 54917 total posts
Name:
..being a mommy and being a wife!
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Re: Health Insurance Provider help
Posted by jessnbrian
Posted by NervousNell
The thing is, it all depends on what plan you are on.
I have Emblem (which was GHI) and we have amazing coverage. But that is because we are on the NYPD plan which is very good.
Other people i know who have the same insurance company have different coverage, different deductibles etc.
It's very individual to the employer/plan rather than the insurance company themselves.
NYPD has a very specific contract with Emblem and the physicians - there are physicians that are only in the NYPD emblem network and NOT with the rest... but that is the except. The rest of the plans listed really don't have variances between plans within them, even Emblem. These are actually very specific plans, totally different from regular commercial plans.
Interesting.
I was talking co pays too, deductibles.
I pay very little out of pocket for anything.
But that is a result of the contract the cops have. Not the plan itself
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| Posted 5/13/15 2:08 PM |
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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: Health Insurance Provider help
Posted by NervousNell
Posted by jessnbrian
Posted by NervousNell
The thing is, it all depends on what plan you are on.
I have Emblem (which was GHI) and we have amazing coverage. But that is because we are on the NYPD plan which is very good.
Other people i know who have the same insurance company have different coverage, different deductibles etc.
It's very individual to the employer/plan rather than the insurance company themselves.
NYPD has a very specific contract with Emblem and the physicians - there are physicians that are only in the NYPD emblem network and NOT with the rest... but that is the except. The rest of the plans listed really don't have variances between plans within them, even Emblem. These are actually very specific plans, totally different from regular commercial plans.
Interesting.
I was talking co pays too, deductibles.
I pay very little out of pocket for anything.
But that is a result of the contract the cops have. Not the plan itself
yup! It's actually a very interesting situation (from a HC administrative nerd perspective).
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| Posted 5/13/15 2:41 PM |
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Mrs&MrsK
i need sleep ;-)
Member since 2/14 2008 total posts
Name:
L
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Health Insurance Provider help
we had emblem thru dw's group and it said on the card NO REFERRALS but everyone thought we needed them.... anyway the copays were higher but they covered more things that we needed, so we doubled up.
i have united but it's self funded/ UMR
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| Posted 5/13/15 2:42 PM |
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raspbrryswl
LIF Infant
Member since 7/10 248 total posts
Name:
Jen
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Re: Health Insurance Provider help
Thank you for all your replies ladies! Is anyone familiar with Medicaid? Do you have to pick a main insurance provider if you get approved for Medicaid? How does it work?
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| Posted 5/19/15 12:46 AM |
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MrsSpring
I'm a lucky mama
Member since 1/10 7585 total posts
Name:
L
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Re: Health Insurance Provider help
call up your childrens dr and ask which state insurance plan they take. my girls have been on united health community plan and ive had no issues at all. all the drs that i want my girls to see takes it.
call up ny state of health. they are very helpful.
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| Posted 5/19/15 6:02 AM |
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raspbrryswl
LIF Infant
Member since 7/10 248 total posts
Name:
Jen
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Re: Health Insurance Provider help
Posted by MrsSpring
call up your childrens dr and ask which state insurance plan they take. my girls have been on united health community plan and ive had no issues at all. all the drs that i want my girls to see takes it.
call up ny state of health. they are very helpful.
thank you! I think I'll make the call.
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| Posted 5/20/15 11:41 AM |
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