Special Surgery And Medicaid: What You Need To Know

The Hospital for Special Surgery (HSS) accepts most major insurance plans for hospital services, but individual physicians may have different insurance policies. HSS is not an in-network provider for some Medicaid plans, including Aetna's Medicare Managed Care/Advantage, Medicaid, Savings Plus, NY Signature, and QHP plans, as well as Anthem of NY Medicare Managed/Advantage and Medicaid Managed Care plans. However, HSS does offer resources to help patients with Medicaid, such as the VOICES Medicaid Education Program, which provides support and information to patients navigating the complex Medicaid system. While HSS may not be in-network with all Medicaid plans, they do accept some, and patients can contact the hospital's financial office for more information.

Hospital for Special Surgery is not an in-network provider for some Medicaid plans

The Hospital for Special Surgery (HSS) accepts most major insurance plans for hospital services. However, it is important to note that the hospital is not an in-network provider for certain Medicaid plans. Specifically, HSS is not in-network for Aetna's Medicaid plans, as well as Anthem of NY Medicare Managed/Advantage and Medicaid Managed Care plans. This means that patients with these specific Medicaid plans may have to pay out-of-network rates or may not have their services covered by their insurance.

It is worth mentioning that HSS does provide resources to help patients navigate the complex Medicaid system. The VOICES Medicaid Education Program offers support, information, advocacy, and assistance to patients in understanding their Medicaid coverage and options under Medicaid Managed Care. This program can help patients request out-of-network authorization if their Medicaid Managed Care plan is not directly accepted by HSS.

Additionally, HSS is a participating provider with Multiplan/PHCS, and their in-network status depends on the specific policy plan. Patients are advised to contact their plan's customer service to determine if HSS will be considered in-network for their particular policy. HSS is also a participating provider with certain NYS Healthcare Exchange/Marketplace plans, such as Empire BCBS Healthplus.

While HSS accepts most major insurance plans, it is always recommended that patients verify their insurance coverage before booking any hospital services. Insurance coverage can vary among individual HSS physicians, and it is the patient's responsibility to understand the limitations of their insurance plan. Patients can refer to the physicians' profiles, contact the doctors' offices, or reach out to the HSS Insurance Advisory Service for the most up-to-date and accurate information regarding accepted insurance plans.

HSS accepts most major insurance plans

The Hospital for Special Surgery (HSS) accepts most major insurance plans for hospital services. However, it is important to note that insurance coverage accepted by individual HSS physicians varies, so it is recommended to verify before booking an appointment.

HSS is not an in-network provider for certain plans, including some Medicare and Medicaid programs. For example, HSS does not participate in Aetna's Medicare Managed Care/Advantage, Medicaid, Savings Plus, NY Signature, and QHP plans. Similarly, HSS is not an in-network provider for Anthem of NY Medicare Managed/Advantage and Medicaid Managed Care plans.

On the other hand, HSS is a participating provider with Multiplan/PHCS, and it is an in-network provider for select programs from various insurance companies, including Aetna, Oxford, and Horizon Blue Cross Blue Shield.

To find a doctor who accepts your specific insurance plan, you can contact HSSConnect at 877.606.1555, or refer to the individual physician profile pages on the HSS website. Additionally, the HSS Insurance Advisory Service can provide the most up-to-date information on insurance acceptance by calling 212.774.2607.

Furthermore, HSS offers financial assistance and resources for patients with Medicaid. The VOICES Medicaid Education Program provides support and guidance to help patients navigate the Medicaid system and understand their insurance options. This program includes information about the Affordable Care Act (ACA) and applying for insurance through the marketplace.

Medicaid Managed Care Plans offer a variety of insurance options

The Hospital for Special Surgery (HSS) is not an in-network provider for Anthem of NY Medicare Managed/Advantage and Medicaid Managed Care plans, Aetna's Medicare Managed Care/Advantage, Medicaid, Savings Plus, NY Signature and QHP plans, or Horizon's NJ Health (Medicaid) and Horizon Medicare Advantage Plans. HSS does accept most major insurance plans for hospital services, and individual physicians may accept different plans, so it is recommended that patients verify their insurance before booking. HSS also provides a VOICES Medicaid Education Program, which helps patients and potential patients navigate the complex Medicaid system and understand their insurance options.

Most managed care plans certified by the New York State Department of Health offer health education classes or other programs to help enrollees stay healthy. Depending on the type of managed care plan, there may be additional services, such as transportation, available to the enrollee. Medicaid Managed Care offers many New Yorkers the opportunity to choose a Medicaid health plan for themselves and their families. Enrollees in Medicaid Managed Care Plans select a primary care practitioner (PCP) who will be responsible for coordinating their healthcare and referring them to specialists or other healthcare providers as necessary.

As of 2022, 75% of Medicaid beneficiaries were enrolled in comprehensive managed care organizations (MCOs), and nearly all states have some form of managed care in place. States decide which populations and services to include in managed care arrangements, which leads to considerable variation across states. Plans have flexibility in certain areas, including setting provider payment rates, and may choose to offer additional benefits beyond those required by the state.

HSS provides financial aid for medically necessary services

The Hospital for Special Surgery (HSS) provides financial aid for medically necessary services based on a patient's financial need. This includes a sliding scale discount for eligible patients. Those who do not have insurance or are underinsured may be eligible for aid. The hospital may also be able to arrange a manageable payment plan for patients. The financial assistance policy applies to services provided by the hospital and some services provided by certain HSS physicians and other clinical staff.

HSS uses poverty guidelines issued by the US Department of Health and Human Services to determine a patient's eligibility for financial assistance. The amount of the discount varies based on the patient's income and family size. The income limits are based on the Federal Poverty Guidelines (the "FPL").

HSS also offers the VOICES Medicaid Education Program, which provides support, information, advocacy, and assistance to patients in navigating the complex Medicaid system. This program helps patients understand their Medicaid coverage and options under Medicaid Managed Care. It also assists patients in requesting an out-of-network authorization if they have a Medicaid Managed Care plan that HSS does not participate with.

It is important to note that insurance coverage accepted by individual HSS physicians varies, so it is recommended to verify this information before booking an appointment. HSS is not an in-network provider for certain Medicaid plans, including Aetna's Medicaid, Anthem of NY Medicare Managed/Advantage, and Medicaid Managed Care plans, and Horizon's NJ Health (Medicaid). However, HSS does participate with other insurance plans and programs, such as MetroPlus, Multiplan/PHCS, and NYS Healthcare Exchange/Marketplace plans.

Medicaid patients can receive support and information from the VOICES Medicaid Education Program

The Hospital for Special Surgery (HSS) is not an in-network provider for several Medicaid plans, including Aetna's Medicaid, Anthem of NY Medicare Managed/Advantage and Medicaid Managed Care plans, and Horizon's NJ Health (Medicaid). However, Medicaid patients can receive support and information from the VOICES Medicaid Education Program, which is designed to help patients navigate the complex Medicaid system and obtain or maintain access to orthopedic and rheumatologic specialty care.

The VOICES Medicaid Education Program offers assistance in understanding Medicaid coverage and options under Medicaid Managed Care. They help patients learn how to request out-of-network authorizations if they have a Medicaid Managed Care plan that HSS does not participate with. The program provides information on other public insurance programs available through the New York State of Health Marketplace, allowing individuals to apply for health insurance through the Affordable Care Act (ACA) and purchase a qualified health plan during open enrollment.

The program also provides support for those enrolled in a NY Medicaid Managed Care Plan that HSS does not participate with, guiding them through the process of obtaining out-of-network authorization. Additionally, the VOICES program offers Medicaid Managed Care information flyers in English and Spanish to help new Medicaid patients understand their insurance options and navigate the system effectively.

To further assist patients, the VOICES Medicaid Education Program provides a list of contact information for various services within HSS. This includes the Appointment Desk, Financial Assistance Program, Insurance Advisory Service, and Physician Referral Service. The program is committed to helping patients access the care they need and ensuring they are well-informed about their insurance options and coverage.

Frequently asked questions